INTRODUCTION TO HEALTH INFORMATION SYSTEMS

Define health information system

Health

It is a state of complete physical, mental and social well being and not merely the absence of
disease or infirmity.

Information

A collection of facts that have been processed into usable form

System

 A collection of units that form a body

 A collection of components that work together to achieve the common objective of the
whole.

Define H.I.S

1. It is information about the people’s health a how the community, government, NGO’s
uses the information to plan and provide quality health care services.
2. Organized and interpreted data about health status, resources, activities and events that
relate to health.
3. A system that collects and presents health information and is responsible for the creation
and maintenance of a data base.

Concept of health information system

Health information system is a system for the collection and processing of data from various
sources and using the information for policy making and management of health services. It could
be paper based or electronic. To apply this to nation, a county HIS integrates data from civil/vital
registration, censuses, population surveys, facility surveys, individual records, services records
and resource records for policy making and efficient management of services. There is a strong
feeling that HIS is a key component of any health system. However, currently the data sources
are incomplete and fragmented. The challenge is to bring together or integrate all these diverse
data sources into one seamless system. Already there is good progress towards this integration by
the use of DHIS

Health information management

It is the practice of maintenance and care of health records by traditional (paper) and electronic
means in hospitals, physician’s office clinics, health departments, health insurance companies
and other facilities that provide health care or maintenance of health records. With the
widespread computerized of health records and other information sources, including hospital
administration functions and health human resources information, health informatics and health
information technology are being increasingly utilized in information management practices in
the health care sector.

Historical background of Health Information system

In 1972, a committee including representatives from, Ministry of Health, Central Bureau of
statistics and the Attorney General chamber was formed.

Its task was to design a health Information System for Kenya.

A pilot project was designed and tested in three Districts;

 Mombasa representing an urban District

 Kitui representing rural District
 Kwale representing peri-urban District

The pilot survey was completed in 1976 and its suggestions and recommendations were adopted.

One of the recommendations was to merge two units that is; Research and Evaluation Unit of the
Division of Family Health and that of Vital Statistics Unit of the Division of Communicable
Disease control into one entity of HIS.

In 1982, another committee of professionals was formed to investigate the accuracy and
efficiency of all health data collection forms.
 The committee suggested a number of changes and as a result all officially approved forms were
changed from MED to MOH with a corresponding code number.

MED was a reflection of the Dept of Medical of one ministry of health (London) when Kenya
was a British Colony.

In 1984, the National policy on District Focus for Rural Development was initiated. In response
to the new development the ministry of health decentralized its reporting activities by
establishing HIS offices in all Districts, where all data from all health facilities within the District
are processed.

Goals and objectives of health information system

Goal of HIS

The ultimate goal is to develop an accessible and comprehensive HIS which is flexible to the
needs of;

 Patients
 Health care providers
 Health managers
 Evaluators and allied health personnel.

Objectives of health information system

A good and effective HIS should;

1. Provide quantitative and qualitative data which is essential for identifying major
programs.

NB; what is a variable?

It is any attribute or event that can have different values.

what is Qualitative and quantitative ?

VARIABLE

Qualitative or categorical Qualitative (measurement)

Nominal (Not Ordinal Discrete Continues
ordered) (Count data) no
[Link] (o rdered)
of children e.g Height
group Eg,Severity
vaccinated
of illness

2. Generate information to be used to evaluate health policies for planning health programs
and efficient management of health services.
3. Open up continuous dialogue between those who collect and the users of the information
with the aim of improving health services.
4. Disseminates timely information to users’ e.g. researchers and health administrators.
5. Provide regular feedback to all personnel in the information system which helps to
emphasis the important role each of them plays.
6. Create and maintain a health information data base at the Sub County.

Personnel involved in HIS

The various individual involved in a typical HIS include;

 Families and communities

 Field health workers e.g Public Health Officers etc
 Clinical staffs e.g Doctors , Nurses etc
 National program health managers and planners
 Sub county health managers
 County health managers
 Health records and information officers
 All the other health workers
Different systems within the HIS
1. In patient health information system
2. Outpatient health information system
3. Management information system

1. Outpatient records

In the outpatient we have information on preventive, curative, health promotion and

rehabilitative services. We have information on vertical programs such as

 Patient support centre

 KEPI currently DVI
 Maternal and Child Health
 Family planning.

Each of these vertical programs has its own health information system. Each information system
gives different health statistics for example from DVI we can get immunization coverage and the
number of mothers who have received tetanus toxoid

The information can be used for planning and management of the health facility.

Several reports are prepared at the outpatient department such as;

2. In patient records

In the inpatient department we collect information on curative services from all patients stay in
the health facilities. Upon discharge the health records personnel collects patients records and
calculates the following hospital statistics, Bed occupancy, ALOS, TOI, VBD etc.

The statistics are used to monitor the operational efficiency of the health facility.

3. Management information system

a) Personnel information system; gives the available manpower and how they have
been deployed.
 b) Facility information system; gives the number of health facilities and the services
they are offering e.g Family planning, immunization etc.
c) Transport information system; gives the number of vehicles and those that are in
working condition.

Standard format of health information system

Health information policy

READ THE HEALTH INFORMATION POLICY (ASSIGNMENT)

Uses of health information

Information is basically used in

1. Planning
2. Policy making
3. Decision making
4. Allocation of resources
5. Distribution of personnel
6. Administrative purposes
7. Research
8. Budget
9. Monitoring and evaluation
10. Forecasting
11. Health education
 12. Intersectoral collaboration
13. Community participation

Functional HIS
Advantages of a functioning health information system:

1. Information is readily available when requested or required, avoiding the last minute
rushes to look for data.
2. Policy makers and managers of program use the information for the health and
development planning and implementation and are sensitized on importance and effective
utilization of Information.
3. Resource mobilization and allocation. Once data is readily available, it is easy to project
the required resources by extrapolating from the past trends with a fairly good accuracy.
Rule of the thumb should not be the norm or the practice.
4. Monitoring trends – Disease surveillance is functional and it is thus easy to predict the
occurrence of epidemics of diseases.
5. Problem and gap identification – Various departments and institutions becomes part of
the system; there is collaboration and co-ordination among various actors.
6. The work and duties of the staff that are involved in the system is appreciated and
recognized.
7. Ad-hoc surveys and consultancies are avoided.
8. Decision making and priority service setting.
9. Operational research and training becomes easy and enables quick retrieval of the
evidences in practice and use evidence based practices for demonstration.
10. Monitoring and evaluation of projects and programmes will be made easier and alongside
working corrective measures or change of strategies will be realized in the initial stages.
11. Donor influence in Health information system is also avoided as in case of reviews.
Guiding principles:
The approach recommended for strengthening National Health Information System (NHIS)
follows a number of principles which have been derived from the assessment of HIS
development experiences around the world and WHO past efforts to support such development.
These principles relate not only to information system design and use, but also to more effective
styles of Technical co-operation.

The overall purpose of these principles is to suggest that health information systems
development must proceed as an integral part of efforts to strengthen the health care system and
that health data be recorded and used firstly, in support of individual care, local health
service operation and community action.

Placing emphasis on the use of data within the services will help increase the completeness and
validity of the data that are selectively reported for supporting decision -making at all levels of
the health system and for supporting health system, planning and development including service
integration. Therefore:-

1. Strengthening the Health Information System at the various service levels should be
undertaken in support of efforts to develop health services and improve their
performance.
2. Any data to be recorded at any service level MUST have an explicitly identified use (for
decision or action in terms of case or community management by staff or community
members) at all levels. An implication of this principle is that no data should be requested
from service levels to be reported to higher levels which do not have an actionable use at
the recording level as well as at the receiving levels.
3. Any changes or developments to data recording and reporting should be made only to
improve the provision of care at the patient and community level, particularly for those
populations most in need. One implication of this principle is that countries,
municipalities or regions should not be encouraged to change their information system
primarily to provide data for central level and International reporting purposes.
4. Each Health administration must assess its needs for clinical and managerial information
based on its mission, goals, priorities, core service responsibilities, levels and functions,
models of service delivery, resources and access to information technology. The Health
Information System should be designed so as to exceed the capability of the
administration to manage it.
5. Great prudence should be applied when making changes to components of health
information Systems that are working fairly well. This applies particularly to reporting
systems of specialized services program such as family planning or Tuberculosis control
or EPI. Overall revision in health service recording and reporting should rarely be
undertaken. Changes in the system should aim to progressively integrate the recording
and reporting system at the local service level.
6. Efforts should be made to make better use of existing data at all levels through practical
analysis, improved presentation of data and efforts to improve the flow and sharing data
across program and services.
7. Practical use of information should be encouraged and supported for database
maintenance and report generation. Such computerization should normally employ
generic software that is widely available database management systems and spreadsheets.
Major computerization efforts should not dominate the selection of indicators and data or
the design of records and reports, but support the improvement of data management
through the application of these principles.
8. The selection and definition of a manageable data set or set of “Essential health
indicators” is recommended as a sound activity for initiating the review and
strengthening of health information systems and for devising a practical National Health
Service monitoring capability. Core health indicators should be chosen for national,
provincial and district use with the following criteria in mind:-

(a) Useful for action. – The data needed for the indicator are useful for the person doing
the recording with recorded data contributing to necessary action being taken with regard
to the case, family, community or district being served.

(b). Relevant for national and program monitoring.- the indicator can serve to
measure progress toward stated national and program goals, objectives, targets, norms
and standards. Such indicators focus on priority health problems in the country and the
services and resources intended to manage those problems. Promotion and use of the
indicator should strengthen routine program management and the health information
system in the country.

(c).Valid, consistent, reliable, representative and sensitive. - the indicators should

possess the normal desirable characteristics of health data, example capable of being
recorded across the services with the necessary degree of validity, consistency, reliability,
representative of all population groups and be sensitive to short term changes in the
variable of interest.

(d) Ease of generation and measurement. - The indicator data should as much as
possible result from normal service and surveillance, usually existing within routine
records and reports.

(e) Understandable: - the indicator should deal with a single clear idea which everyone
will see as an important measure. Composite indexes should be avoided.

(f) Ethical: - Data collection, including the choice of the data source, computation of the
indicator and its use should not conflict with accepted ethical values.