Lesson 5
Health Status – quality of life that a patient leads
Health Information System – cover different systems that
capture, store, manage and transmit health-related
information sourced from individuals or activities of health
institution useful for policy making and decision.
 Includes PAS (Patient Administration System); LIS
(laboratory Information system) ; HRMIS (human
resource management information systems.
HIS – mechanism keeping track of all data related to a
patient and patient’s history. Roles of well-implemented
HIS:
1. Easier access to files
2. Better control
3. Easier update
4. Improved communications
A good information system delivers accurate information in
a timely manner, enabling decision makers to make
informed choices about different aspects of health
institution.
COMPONENTS OF HIS (defined by Health Metrics
Network)
1. HIS Resources – framework on legislations,
regulations, planning and resources required for a full-
functional system. (personnel, logistics, support)
2. Indicators – basis of HIS plan and strategy; (health
system inputs, outputs and outcomes)
3. Data Sources – 1)population-based (census, civil
registration) 2)institution-based data (individual
records, resource records and service records)
4. Data Management – handling of data, collection and
storage to data flow and quality assurance, processing,
compilation and data analysis.
5. Information products – data transformed into useful
information providing insight to health actions
6. Dissemination & use – information readily available to
policymakers and data users.
INPUTS – HIS resources (health, institutional coordination,
HIS policies, infrastructures, human policies.)
PROCESS – indicators, data sources, data management
OUTPUT – data transformation into information used for
decision making and dissemination/use.
Data Sources:
1. Demographic Data – facts about a patient (age, b-day)
2. Administrative Data – services such as diagnostic tests
or out-patient procedures, kind of practitioner,
physician’s specialty, nature of institution.
3. Health Risk Information- lifestyle and behavior of
patient and medical history/genetic factors. This is
used to evaluate the patient’s propensity for possible
diseases.
4.
crucial to his/her health. Cognitive, social functioning
5. Patient Medical History – info on past medical
encounters, hospital admissions, pregnancies.
Previous illness and family history.
6. Current Medical Management – patient’s health
screening sessions, diagnoses, allergies, current health
problems etc.
7. Outcomes Data- measures of aftereffects of healthcare
and health problems. Usually show health care events
and measures of satisfaction with care.
Health Management and Information System
 Specially designed to assist the management and
planning of health programs as opposed to delivery of
care.
Health Component of HMIS – clinical studies to understand
medical terminologies, clinical procedures and database
processes.
Management - principles that help administer health care
enterprise
Information system – ability to analyze and implement
application for efficient and effective transfer of patient
information
HMIS developed thru concepts (Republic of Uganda
Ministry of Health Resource Center, 2010)
 Relevant to policies and goals of the health care
institution
 Functional used immediately for management
 Integrated for there is one set of forms and no
duplication of reporting
 Collected on a routine basis from every health unit
Role of HMIS – provide quality information to support
decision making at all levels of health care system in any
medical institution.
1. Needs to be complete, consistent, clear, cost-
effective. Accessible and confidential.
FUNCTIONS OF HMIS
Data input
o Data acquisition – generation and collection of
data through coded format input
o Data Verification – authentication and
validation.
Data Management – processing phase
o Data Storage- preservation and archiving of data
o Data Classification – data organization which sets
efficiency of the system.
o Data Computation – forms of data manipulation
and data transformation. Allow data analysis,
synthesis and evaluation.
o Data Update – changing information and requires
constant monitoring.
Data Output –
o Data retrieval – process of data transfer and data
distribution. Identify and acquire data from
database.
o Data presentation – retrieval/fetching. Reporting
of interpretation
Functions of HMIS
1. Client data – information of the client related to her
transactions
2. Scheduling – distribute resources to areas in need.
3. Authorization Tracking – monitoring of authorized
personnel and their use of authorized units
4. Billing – notification of charges for patient
5. Accounts Receivable- customers are properly notified
about their bill and settle with it accordingly.
6. Reporting – reports issued by entity
7. Medical Record- HER, collection of digital information
about a patient
8. Compliance- procedure to be followed for
improvement of condition of patient
9. Financial Data – information relating to the
performance of entity collected for administering.
Determinants of HMIS Performance Area
 Behavioral Determinants. Behaviors of data collectors
and user
 Organizational Determinants – factors affecting
development of HMIS process
 Technical Determinants. Overall design used in
information collection.
PRISM Framework
Performance of Routine Information Systems – broadens
analysis of HMIS or RHIS including 3 determinants
 Behavioral- knowledge, skills, attitudes, values,
motivation of people
 Organizational/Environmental- information
culture, structure, resources, roles
 Technical- data collection process, systems, forms,
methods
HMIS in PH – BlackBox, Zygwork
PRISM – identifies strengths and weaknesses in certain
areas as well as coorelations among areas.
Lesson 7
HMIS Monitoring and Evaluation
 Assist in planning and management of national heath
strategy plans
 Assess effect of integrated service delivery
Monitoring- collection, analysis and use of information
Evaluation – systematic assessment of completed
programs and policies.
M&E Framework – strengthening common country
platform for better alignment in monitoring of funding
4 Components:
(1) Indicator domains (2)data collection (3)analysis
and synthesis (4)communication use
HAMIS – program app of HMIS
 Partnership w/ DOH & German Agency for Technical
Cooperation in 1989
 Develop need-responsive & cost-effective health
management system
Assessment tools – need for accurate info, comparative
information, normative information
Application under HAMIS
1. Blackbox – vital health statistics
2. Homisbox- secondary computerization&
simplified data on hospital care
3. Lucena – Development of hospital information
system starting with admission
4. Maramag – late/many loopholes/ development of
up-to-date neglected financial management
5. Updated PhilHealth System- design of information
system on health financing and health insurance
6. Brownies – simplified collection, retrieval of
cultural, social and economic background data
7. Databoard – promotion of simplified community
based spot mapping of heath assessment matrix
Utilization of HMIS to know:
 What are our health problems?
 What are we doing about them?
 What else should we do?
 How best should we manage our health resources
to this end?
Internal M&E – supportive and record checking of periodic
interval by dep’t heads, supervisors, managers
Externa M&E – operational monitoring & record checking
at periodic interval by gov’t agency/independent NGOs
M&E PLAN – address components of the
framework/generate information for global monitoring
based on health sector review processes.
M&E and HMIS Indicators
Indicator- variable measuring value of change in units
telling past, future events
The focus is on a single aspect of a program such as input,
output.
United States Agency for International Development
(USAID) indicators:
1. Reproductive Health
2. Immunization
3. Disease Prevention and Control
4. Resource Utilization
 5. Data Quality
Lesson 6
HMIS Indicators and Health Programs
1. Pregnancy care Interventions
2. Child Mortality and Child Survival Interventions
o Child 21 – Philippine National Strategic Framework for
Plan Development for Children 2000 – 2025
(framework for policymaking and program planning
as roadmap for interventions aimed at safeguarding
welfare of Filipino children.
o Children’s Health 2025 – subdocument of Child 21
focusing on the development of Filipino children and
protection of their rights
o Integrated Management of Childhood Illness (IMCI) –
aims to lower child mortality caused by common
illnesses
o Enhanced Child Growth – intervention aimed to
improve health and nutrition of Filipino children by
operating community-based health and nutrition
posts.
Lesson 8
HMIS DATA QUALITY
RA 10173 – Data Privacy Act of 2012.
 Act protecting personal information and information
on communication systems
 Data Quality – overall utility of databases as function
of its ability of be processed easily and analyzed for
database, data warehouse, data analytics system.
 Data Subject - individual whose personal information
is processed.
 Consent of Data Subject – freely given, specific
informed indication of will about info process.
 Consent – evidence by written, electronic, recorded
 Filing System – info relating to natural juridical
persons to the extent that it is structured by reference
of individuals / readily accessible.
 Information & Communications Systems – generating,
sending, receiving, storing, processing electronic data
messages/documents
 Personal Information – identity of individual
 Personal information controller – person/organization
controlling the collection, holding, processing and use
of information
 Processing – operation performed on personal info
 Sensitive personal information – race, ethnic origin,
color, marital status, political affiliations, health etc.
Rights of Data Subject
(a) Informed that personal info has been/being processed
(b) See furnished info before entry to processing system
of PIC
PIC (Personal Information Controller should provide:
(1) Description of personal info (2) purpose (3) scope and
method (4) recipients of info (5) methods (6) identity
and contact details of PIC (7) period (8) existence of
rights, access, connection
 Principe Accountability – responsibility of PIC
Aspects of Data Quality:
accuracy , completeness, relevance, consistency, reliability,
presentability, accessibility
Data Quality – signifies data’s appropriateness/purpose
Data cleansing can be done to raise the quality of data.
LQAS – LOT QUALITY ASSURANCE SAMPLING
 Tool allowing small use of random samples to
distinguish between different groups of data elements
w/ high or low quality.
RDQA – ROUTINE DATA QUALITY ASSESSMENT
 Simplified version of Data Quality Audit (DQA) allow
programs to verify and assess quality of reported data.
Objectives of RDQA (RDQA User Manual, 2015)
1. Verify quality of reported data for key indicators
2. Implement corrective measures with action plan for
strengthening data management and reporting system
and improving data quality.
3. Monitor capacity improvements/performance of data
management and reporting system to produce quality
data.
Development Implementation Plan
 Illustrate how a project is expected to progress at high
level. Ensures development team is working and
complete task and deliver on time.
Key Steps:
1. Define Goals/Objectives
2. Schedule Milestones
3. Allocate Resources
4. Designate team member responsibilities
5. Define metrics for success.
DATA QUALITY TOOLS
 Analyze information and identify incomplete or
incorrect data. Data cleansing follows after complete
profiling of data concerns.
How data tools are sued to address problems:
 Parsing & Standardization – decomposition of fields
into component parts
 Generalized “cleansing”- modification of data values to
meet domain restrictions.
 Matching- identify and merge related entries
 Profiling – analysis of data to capture
statistics/metadata to determine quality and issues
 Monitoring- deployment of controls to ensure
conformity of data
 Enrichment- enhancement of data value using related
attributes (demographic, geographic)
ROOT CAUSE ANALYSIS
 Problem solving method identifying root cause of
problem or events.
 Aim: improve quality of products/services
Techniques in Root Cause Analysis
 Failure mode and Effects Analysis (FMEA)
Find various modes of failure within system and
address questions:
1. What is the mode in which an observation
failure occurs?
2. How many times does a cause of failure occur?
3. What actions are implemented to prevent this
cause from occurring again?
4. Are the actions effective & efficient?
Used when there is new product/process or
changes/updates in product.
 Pareto Analysis – uses Pareto Principle
20% of work creates 80% results. Used when there
are multiple potential causes to problems.
 Fault Tree Analysis (FTA) – used in risk and safety
analysis. Uses Boolean logic to determine root cause
of undesirable effect. Undesirable result at top of tree
potential causes down.
 Current Reality Tree (CRT) – used when root causes of
multiple problems need to be analyzed at once.
 Fishbone Diagram (Ishikawa/ Cause-and-effect) –
categorized causes and sub-causes of a problem.
 Kepner-Tregoe Technique – breaks problem to its
root cause by assessing situation using priorities and
orders of concern for issues.
 Rapid Problem Resolution (RPR Problem Diagnosis)-
diagnose the cause of recurrent problems by:
1. Discover – data gathering/analysis of findings
2. Investigate-create diagnostic pan and identify
root cause
3. Fix- fix and monitor problem to confirm and
validate correct root cause
SUSTAINING A CULTURE OF INFORMATION USE
Information culture is determined by variables: mission,
history, leadership, employee traits, industry, national
culture.
Also shaped by cognitive and epistemic expectations
influenced by the way tasks are performed and decisions
are made.
Lesson 9
Hospital Information System – manage all records of
health care providers to make available info and reports
useful to health care personnel. (introduced 1960)
Aim: achieve best possible support of patient care,
outcome, administration by presenting data when
generated with network e-data processing.
Benefits: (1) enhance facts integrity (2) reduce
transcription errors (3) reduced duplication of facts entry
(4)optimized report turnaround times
The systems gather, process, retrieve patient info , provide
hospital stakeholders with relevant info thru reports for
decision-making.
HIS FOR DIFFERENT DEPARTMENTS
1. Nursing Information Systems – enhance patient care
– provide nurses with accurate info to assist them.
NIS carries functions: persona; schedule, accurate
patient charting, clinical integration.
2. Physician Info Systems- improve practice of
physicians. EMR/HER used in PIS.
3. Radiology Info Systems- provide billing services &
appointment scheduling; reporting; database storage.
4. Pharmacy Info Systems – monitor utilization of meds
in health institutions. Handle info on medication-
related complications; drug allergies of patients.
SELECTING HOSPITAL INFORMATION SYSTEM
1. Total cost of package – HIS available for all sizes and
budgets. Providers reduce upfront and maintenance
fees using designs (few server/hardwares)
2. Web-based system – available on internet; authorized
personnel access info anywhere, anytime. Allow data
sharing between hospitals.
3. Implementation & Support – vendor provide training
and assistance to users of system.
HIS Providers in PH
 BizBox Inc. (25 yrs ago) – 1st hospital project
completed (1994). Goal: improve work efficiency in
HCIs thru software systems, produce advance
solutions for better patient care.
 KCCI Medsys (Kaiser dela-Cruz Consulting Inc.) –
application development for hospitals, industrial,
medical related institutions. Visual Medsys (hospital);
MEDSCHO (schools) provide integrated,
comprehensive, proven solutions
 COMOLGIK Business System Inc. (1999) – PH based
software. Vision: to be global technology company
 Develop innovative applications (hospital service
where patient access billings etc.)
HIS Functions
 Help Desk- manual retrieval of info no longer needed
thru HIS. Clients are provided with information,
guidelines w/ companies’ products/service.
 Scheduling- managers/employees access wok scheds
anywhere and discuss schedule thru HIS. Save time;
employee scheduling less difficult.
 Patient Registration- form records (name, age, marital
status, etc) for record-keeping and account
management. Filled during patients visit/consult.
 Admission – admission counselor call patient for
prelim info before admission in HCIs. Physicians can
schedule recurring med exams, lab tests, x-rays.
 Discharge – thru HIS, info on patient discharge/
transfer are easier/efficient.
 Transfer- movement along w/ discharge of person out
of HCI @ instruction. Does not encompass:
a. Individual declared lifeless
b. Leaves facility without permission
If patient is transferred from ER, employees must fill
statutory requirements.
 Billing- billing statement show records- invoices,
payments, current balance of patients account.
 Contract Management- managing contract creation,
execution & analysis to maximize operational &
financial performance of organization while reducing
financial risk. Time consuming.
When implemented successfully:
a. Realization of expected business benefits and
financial returns
b. Cooperation and responsiveness of supplier to
orgs need
c. No contract disputes/surprises
d. Satisfactory delivery of service to both parties
 Package Deal Designer- access info regarding package
deals without going thru hassle paperwork.
Laboratory Reporting – all lab reports must possess
common elements required by institutional policies.
Contain items no required but laboratory choose to
report to aid in interpretation of results.
- For identification and filing purposes, laboratory
reports display info with administrative or clerical
info:
(1) Patient name/identification number
(2) Name/address of lab location
(3) Date when report printed
(4) Test report due
(5) Name of doctor/authorized person
- Info about specimen and tests
(1) Specimen source
(2) Date/time of specimen collection
(3) Lab accession number
(4) Test performed
(5) Test results/ abnormal test results
(6) Unit of measurement
(7) Reference intervals
(8) Interpretation of results
(9) Specimen condition
(10) Deviations
(11) Meds/supplements
Radiology reporting- official medical document
provides details of requested radiology exam and
procedure done by radiologist. PHYSICIAN
INTERPRETS RESULTS. (basic sections: clinical
history, admin info, patient identification, clinical info,
imaging technique)
Cardiology Reporting – contain important med info
based on test results of patients set against past info.
Doctors write vascular reports faster since access and
retrieval are faster. Using CIS, vascular sonography
reports are accurately created. (info reports:
ultrasonic ultrasound/diagram.
MATERIALS MANAGEMENT SYSTEM (Pharmacy, Main
stores, Purchase)
Materials Management – planning, identifying, purchasing,
storing, receiving and distributing materials. Purpose:
guarantee that right and sufficient materials in the right
location when needed.
Computerized stock management systems- technologies
for tracking inventories & devices used each day. Use
barcodes and RFID tags w/ precise identification numbers
enable accurate tracking and control.
Management Reporting –
- not limited to data retrieval. Platform for
reporting/controlling information valuable to
institution.
- Capture necessary data required by management to
headcount, customer account info, funding, overall
performance of data.
- Offer holistic view highlighting high values sources
and eradicates lack of visibility in reviewing
performance of institution.
In-Built Tally Interface (Tally.ERP9) – software provide
simplified solutions to operations in health institutions
(registration, accounting, inventory management, tax
management)
- Easy to learn/implemented with minimum
resources. Used by 1,000,000 entities across globe.