ROUTINE HEALTH INFORMATION SYSTEMS

A Curriculum on Basic Concepts and Practice

MODULE 8:
Information and Communication Technology for RHIS

SESSION 3:
Patient-Centered Information Systems
The complete RHIS curriculum is available here:
https://www.measureevaluation.org/our-work/ routine-health-information-systems/rhis-curriculum

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Learning Objectives and Topics Covered

Objectives
•Define what patient-centered information systems are
Topics Covered
•Electronic medical records (EMRs) and aggregate-
information systems
•Types of EMRs
•Benefits of EMRs
•Patient unique identifiers (PUIDs)

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Electronic Medical Records

• Contain data related to a single patient, such as diagnosis,

name, age, and earlier medical history
• Data typically based on a single patient/healthcare worker
interaction
• Systems used largely by clinicians for diagnosis and
treatment, but also by administrative staff for accounting
and file management
• EMR is not just one system; it may include interfaces with
many other systems and applications

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Aggregate Information Systems

• Contain consolidated data relating to multiple patients, and

therefore cannot be traced back to a specific patient. They
are merely counts, such as incidences of malaria, TB, or
other diseases.
• Aggregated data are used for the generation of routine
reports and indicators, and for strategic planning and
guidance within the health system.

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Types of Electronic Medical Records

• Custom-developed
• Commercial off-the-shelf
• Free prepackaged
• Open-source software
• Software as a Service (SaaS)

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Acquisition Assessment Matrix
TYPE
Custom-developed:
application built from
scratch
PROS CONS
- -
Controls design to serve specialized needs Initially requires more time and budget
- Development fosters innovative capacity, - Needs development team
sustainable ownership - Depends on availability of long-term
- Able to engage local IT industry support

Commercial off-the shelf: - -

Short time from selection to implementation
a commercially available
product - Able to evaluate before buying; app is
maintained and upgraded (at a cost)
- Typically pretested and reliable
May not fit country needs
- May be expensive or have complex fee
structure
- May not be designed for low-resource
environment

Free prepackaged:
app developed by donor,
university, or other project or
country
- -
Shorter lead time May lack accompanying IT support and
- Able to evaluate before buying warranty
- -
Less upfront cost, but there are costs to Hidden implementation and maintenance
customize and maintain costs
- May not be suitable for or adaptable to
country needs

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Acquisition Assessment Matrix
TYPE
Open source:
source code and software
freely
available
Software as a Service (SaaS):
hosted on a remote server and
provided in increments
PROS CONS
- -
Lower development costs Product may not be supported
- Able to adapt software - Open source community may be too
- Able to engage local IT industry fragmented to rely on
- Benefits from open source communities, if - Hidden implementation and maintenance
available costs
- -
Easy to implement; maintain Data hosted on remote servers, which may
- Clear cost structure conflict with privacy or policy
- Upgrades can be shared easily (maybe at a - Governments may not be able to take over
cost) regular fee
- May not be suitable for or adaptable to
country needs
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EMR Benefits

• Individual patient data that are collected and accessible at the point of
care can support clinical management
• Generates warnings for abnormal laboratory and imaging results
• Provides reminders for appointments, routine screenings,
prescriptions, administration of vaccines, and other health
maintenance benefits
• Improves legibility of clinical notes, reducing clinical errors associated
with illegible handwriting
• Better diagnosis of disease and mortality (linked to ICD-10)
• Facilitates speed and accessibility in obtaining consultations from
distant specialists (referral systems)

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EMR Benefits

• Supports service monitoring (reporting outcomes, budgets,

and supplies)
• Data back-up and archiving
• Easy information transfer and sharing with other databases
• Supports clinical research

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EMR Implementation Considerations

• Poor IT infrastructure (power outages; limited network

connectivity and bandwidth) increases the cost to set up
and maintain the systems
• Limited healthcare staff with heavy workload
• Insufficient investment in research to develop patient-
centered information systems that would meet the needs of
a particular healthcare system
• Security, confidentiality, and reliability

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EMR Implementation Considerations

• Technology, access, and interoperability

• Staff buy-in and political will/buy-in (IT culture:
behavioral aspects)
• Licensing and contracting
• Timelines
• User fit: Does system fit well within existing culture,
language, and user workflows?
• Sustainability and adaptability
• Scalability

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Patient Unique Identifier (PUID)

• Numeric or alphanumeric string that is associated with

a single patient within a given health register or a
health-records system
• PUIDs should be portable across different systems

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PUID Components

• An identifier (numeric; alphanumeric) scheme

• Identification mechanism
• Index links the PUID and the identification information of the
patient
• Mechanism to hide or encrypt the identifier
• Technology infrastructure to search, identify, match, encrypt,
etc.
• Administrative infrastructure including the central governing
authority

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PUID: Functions and Objectives

• Support the protection of privacy and confidentiality

through accurate identification (explicit identification of
patient information) and dis-identification
(mask/encrypt/hide patient information)
• Help prevent, detect, or mitigate problems caused by
duplicate records and patient mix-ups or mistaken identity

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PUID: Functions and Objectives

• Help retrieve a complete history of patient’s medical history

regardless of where patient received services
• Provide positive identification of patient for delivery of
care and administrative functions
• Track patients across multiple facilities (locations),
systems, programs, or services; hence supporting the
continuum of care

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Discussion

• Do EMRs contribute important benefits to healthcare

projects?
• Do EMRs have a beneficial impact on patient care?
• What EMR implementation challenges have you
faced?

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 ROUTINE HEALTH INFORMATION SYSTEMS
A Curriculum on Basic Concepts and Practice

This presentation was produced with the support of the United States Agency for International Development
(USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004.
MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at
Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health;
Palladium; and Tulane University. The views expressed in this presentation do not necessarily reflect the
views of USAID or the United States government.

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