Health Information

System in Sri Lanka

by
Dr Sunil Senanayake
MBBS, MSc, MD
Director/Health Information
 Information System
Components of National HMIS:
–Hospital Information System
–Preventive Health Information System
–Disease Surveillance System
–Population Census
–Surveys
–Other special surveys (NCD Risk Factor
Survey)
 Sources of Information
Hospital Information System:
–Clinical Data
–Diagnosis of diseases (Using ICD-10)
–Procedures performed
–Cancer Registry
–Cause of Death (Hospital deaths)
–Hospital facilities
–Hospital services
 Sources of Information ctd…
Preventive Health Information
System:
–Maternal, Child Health and FP data
–Food Sanitation, Environmental &
Occupational Health data
–Nutrition data
–School Health data
–Immunization data
–Data from Disease Control Programmes
Sources of Information ctd…
Disease Surveillance System:
–Mainly Communicable Diseases
–Monitoring of disease trends
–Leading causes of Hospitalization
•Ischaemic Heart Diseases
•Hypertension and complications
•Cancers
•Diseases of elderly
 Sources of Information ctd..
Population Census:

National Census:
–Started in 1881
–Every ten years (except 1991)
–Wide range of information
 Sources of Information ctd..
Surveys:

1. Demographic and Health Survey:

–Started in 1973
–Every five years
–Support Health Information
–Confirm Health Information
Sources of Information ctd..

Surveys: ctd…

2.Household Income Survey:

–Nutritional status
–Energy consumption
–Common Health Problems
–Expenditure pattern
Sources of Information ctd..
Surveys: ctd…

3. Nutrition Survey:
–Nutritional status
–Nutritional disorders
–Energy consumption
–Vitamin deficiencies
–Micro-nutrient deficiencies
Sources of Information ctd..
Surveys: ctd…

4. Other Special Surveys (NCD RF

Survey):

–NCD Risk Factor Survey

–Injury Surveillance
 Sources of Information ctd..

Other Sources Health Related Data:

–Alcohol and Drug Information Centre
–National Dangerous Drugs Control Board &
Police Narcotic Bureau
–Non Governmental Agencies
–Sri Lanka Customs
–Trade and Commerce Ministry
•Food, tobacco, alcohol etc (imports & sales)
 In the past ……………..
Some of the remarkable achievements ….
-Well established health infrastructure
-Very good preventive health care service
-Eradication of diseases
-One of the world best EPI programmes
-Better health Indicators for the
investment
-Model for low cost health services
-- Among many other things …...
 Recent past …….

-Health for all by 2000

-Primary Health care approach
-MCH and FP
-Immunization
-Health Education
-Disease prevention
-Healthy environment etc……
 Future problems …….

• Changing demography
• Changing disease pattern
• Changing life styles
• High expectation of people
• Equity
• Responsiveness
• Technological advances etc……
 Our strategies ………….
-Improve ambulatory care
-Concentrate on Non Communicable Diseases
-Integrated Disease Surveillance
-Rehabilitation in the community
-Promote healthy lifestyles
-Ensure equity
-Exploit IT
-Better dialogues between clinicians, public
health personnel, researchers & planners
 Issues
There are many Issues: (Hospital)
–Manual Record keeping system
–Only inpatient data
–Only from Government Hospitals
–ICD10 at Hospital but aggregated
groups are transmitted to the centre
–Doctors do not concern about writing
of diagnoses
 Issues ctd…
There are many Issues: (Hospital) ctd…
–Inadequate human resources
–Untrained coders
–Patient record formats
–No established Medical Record Departments
in some hospitals
–No unique ID
–Repeated admissions counted as new cases
–Use of IT is minimal
 Issues ctd…
There are many Issues: (Public Health)
–Total system is manual
–Behind time
–Processing is difficult
–No/weak data from
•Estate sector
•Occupational health
•Nutrition surveillance
•Health education
•NCDs
 Issues ctd…
There are many Issues: (Other)
–Poor Financial Information
–No unit cost system
–No Disease burden study
–No routine NCD surveillance system
–HIS policy has not been laid down
 Challenges
Hospital System:
–Re-designing the hospital record
keeping system
–Changing of record keeping formats
–Adaptation of ICD 10 at all hospitals
–Transmitting of data by ICD 10 4
digit level
 Challenges ctd..
Hospital System: ctd..
–Changing of attitudes of doctors
–Introduction of ICD 10 to basic
curriculums
–Introduction of IT to hospitals (EPR)
–Development of IT Networks in
hospitals
–Training of users
–Quality of Medical Records
 Challenges ctd..
Public Health System:
–Introducing IT at lowest possible
level
–Development of suitable software
–Development of routine NCD,
nutrition and occupational disease
surveillance systems
–Integration of disease surveillance
systems
 Challenges ctd..
Other Systems:
–Introduce a Unit cost system
–Updating of Human Resource
Information System
–Mapping of Health Facilities (GIS)
–Convincing Policy makers and
decision makers on investment in IT
in Health
 Challenges ctd..
The biggest challenge is “get
decision makers and policy makers
to use information for decision and
policy making.”

Therefore “evidence based decision

making culture” has to be promoted
among them.
 Challenges ctd..

Information dissemination would

be one of the strategies that could
be adopted to overcome this
situation.
Dissemination of Information
•Annual Health Bulletin
•Annual Administrative report
•Weekly Epidemiology Bulletin
•Quarterly Epidemiology Bulletin
•Annual Family Health Report
•Census reports
•DHS reports
•Survey reports
•Health Ministry Website
 Current status of IT Facilities
IT Facilities available:

–Ministry of Health has a Local Area Network with a

dedicated e-mail service and Internet services.

–All the Provincial Health Offices and most of the

District Offices are connected to the LAN of the
Ministry of Health via dial-up lines for electronic
data transfer.

–Network will be expanded to MOH Offices and

large hospitals by end of 2005.
 Opportunities
•Millennium Development Goals
•Health sector master plan
•WB assisted Health Sector
Development project
•E-Sri Lanka project
•Government budget monitoring
mechanism
 Thank You!

Dr Sunil Senanayake
sunil@health.gov.lk
sunilsenanayake@hotmail.com