Introduction and setting the stage: Integrated Health Information Architecture

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

What is health?

What is healthservice quality?

 Political commitment to health as a social goal

 Societal values of equity, political participationand community involvement in health

 Investments in Primary Health Care

 Widespread education (women)

Societal factors contributing to health

1)to understand and influence how the health care service deliveryoperates: 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 on

What make a successful health system?

WHO Health System building blocks

Human resources

Source: Good Health at Low Cost 25 Years on

What 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 towardsmanaging hiring, distribution, payment,education, and certification of staff, over time

Electronic Medical Records (EMR)

-Are related to patient care, and focus onpatient data (name, age, symptoms, medicalhistory, test results etc)

-Functionality around patient care,registration symptoms, test results, medicineprescription, referrals, billing, etc.

EMR: Support Patient workflow

Logistics Management InformationSystems (LMIS)

-Related to the logistical tasks arounddistributing health related commodities,such as vaccines, medicines, instruments,etc

-Functionality for inventory management,ordering and procurement, trackingcommodities, certifying suppliers, forecastingetc

Health information subsystems

A National health information system consist of several subsystems

Routine data collection based on patient and service records andregular 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 /programtracking

Individual /programtracking

Aggregate data

Aggregate data

Some benefits of good HIS

-providing (continuity of) care to patients (medical staff)

-assist decision makers in detecting and controllingemerging and endemic health problems

-monitor progress towards health goals/targets (MDGs)

-promote equity (many not counted!)

-strengthening the evidence base for effective healthpolicies

-permitting evaluation of health system interventionsover time

-ensuring accountability in the way resources are used

HIS around the world

Huge differences between national health informationsystems (HIS), however generally a move from paperto 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

Typical national HIS setup

Integrated Health InformationArchitectures (IHIAs)

An overall framework for how these various information systemswork together (HMIS, EMR, HRIS, LMIS, etc)

Integrated (appearing as one)

–Working together, sharing definitions and data acrossinformation systems

Architecture

–Collection of sub-systems; organized to form a whole, buthave different roles

–An architecture describes roles and relationships betweensystems

IHIA as a system of systems, theirroles, and relationships

HMIS

EMR

HRIS

Lab.IS

LMIS

IHIA

Why is it important with IHIAs?

To share data

–powerful analysis by combining data sources

–improve quality by reducing duplication andmanual transmission of data

Resource optimization

–reduce duplication of data collection

–reduce development and maintenance ofoverlapping systems

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 manysources Payroll at Ministry of Finance, HR System at Ministry of Health Licensure and Registration from councils

•Combining these two data sets across multiple systemsallows 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 worktowards an IHIA

Donors changing approach: Paris declaration (2005)

–build on local systems; local government decisions, but stilldonor specific reporting requirements

–collaboration between donors (harmonization), but hard toaccomplish in practice

–shift funding towards evidence-based interventions, butdependent on reliable information

Data warehouse

-A database compiled from differerentsources, designed to process and presentdata for a multiplicity of users, based on theirneeds

-For an IHIA, a data warehouse shouldcontain data from all the subsystems relatedto health, including service data, census,surveys, environmental data etc.

-Also called an integrated data repository