Health Management Infor-

mation Systems
Why health information system?
• Good management is a prerequisite for increasing the effi-
ciency of health services.
• Improved health information system is clearly linked to good
management.
• Information is crucial at all management levels of the health
services from periphery to the centre. It is required by poli-
cymakers, managers, health care providers, community
health workers.
• “Changing the way information is gathered, processed, and
used for decision-making implies changing the way an orga-
nization operates.”
Definitions
System - Any collection of components that work together to achieve a common ob-
jective.
Health System - All the activities whose primary purpose is to promote, restore or
maintain health.
Information - Meaningful collection of facts or data.
Information System - Systems that provide specific information support to the deci-
sion-making process at each level of an organization.
Health Information System - A set of components and procedures orga-
nized with the objective of generating information which will improve
health care management decisions at all levels of the health system.
The ultimate objective of health information system is not “to gain in-
formation” but “to improve action”
 What is wrong with current health MIS?
• Irrelevance of the information gathered
• Poor quality of data
• Duplication and waste among parallel health in-
formation system
• Lack of timely reporting and feedback
• Poor use of information
• The difference in culture between data people and
decision makers: Planning and management staff
rely primarily on “gut feeling” to formulate ad hoc
decisions rather seek pertinent data.
Step 1: Identifying information needs and feasible
indicators
Step 2: Defining data sources and developing data
collection instruments for each of the indicators se-
lected
Step 3: Developing a data transmission and pro-
cessing system
Step 4: Ensuring use of the information generated
Step 5: Planning for health MIS resources
Step 6: Developing a set of organizational rules for
health information system management
 Steps involved in restructuring of Health MIS
Step 2: Defining data sources and developing
data collection instruments for each of the indica-
tors selected
Step 3: Developing a data transmission and pro-
cessing system
Step 4: Ensuring use of the information generated
Step 5: Planning for health MIS resources
Step 6: Developing a set of organizational rules
for health information system management
Step 1: Identifying information needs and feasible indica-
tors

• Identifying information needs for follow-up of a preg-

nant woman in a primary level
• Identifying indicators to ensure efficient drug man-
agement in a referral hospital
• Identifying indicators to ensure efficient Information,
Education and Communication in the community
• Identifying indicators to monitor the quality of super-
vision by the district management team
Step 2: Defining data sources and developing data collec-
tion instruments for each of the indicators selected

• Develop an appropriate record form for follow-up of

haemo-dialysis in a tertiary care hospital
• Develop a monthly reporting form for activities per-
formed in a primary level clinic
• Define data sources for a situational analysis at the
district level
• Develop data sources for monitoring the quality of
teaching in a medical college
 Step 3: Developing a data transmission and process-
ing system
• Structure the information flow on pregnant women
between the traditional birth attendant and midwife
in the health centre
• Ensure that monthly report forms from health cen-
tres are entered in the district computer in a timely
and accurate manner
• Develop a mechanism for reporting of Research done
in a research centre
 Step 4: Ensuring use of the information generated
• Develop user-friendly feedback formats for regional
mangers on the utilization of inpatient services in
the region
• Train health auxiliaries in follow-up procedures for
hypertension patients using a standard record form
• Develop a curriculum for the undergraduate and
post-graduate students depending upon the need in
the country
• Ensure research on the priority health issues for the
country
 Step 5: Planning for health MIS resources

• Create positions of computer operators in cases where dis-

trict level data processing is computerized
• Submit revised recurrent cost budgets based on proposed
new data collection procedures

Step 6: Developing a set of organizational rules for health in-

formation system management
• Develop standard case definitions
• Change the job description of doctors in cases where health information
system restructuring involves their active participation in data collec-
tion
• Develop an instruction manual for computer operators
 Information process

Data collection
Resources
Data transmission
Management
Data processing
Organizational rules
Data analysis

Information for use in

planning and management
 Ways to enhance the use of information
in decision-making

• Characteristics of the data

• Characteristics of the problems and the decisions
they require
• Organizational or structural characteristics
• Cultural differences between ‘data people’ and ‘ac-
tion people’
• The communication between the two
 Characteristics of the data
• Ownership and relevance
• Validity and reliability
• Aggregation of data
• Customizing information to the users’ needs
• Timeliness of feedback
 Sybsystems of Health Information System
WHO proposes to categorize the health information
system under five interrelated “subsystems”:
• Epidemiological Surveillance (notifiable infectious dis-
eases, environmental conditions, and risk factors)
• Routine service reporting
• Special programmes reporting systems (tuberculosis
and leprosy control, MCH, school health)
• Administrative systems (health care financing systems,
health personnel systems, logistic systems)
• Vital registration systems (births, deaths, and migratory
movements)
 Communication
• Communication process within a health team
• Feedback process
• Communication products
– Time comparison
– Geographical comparison
– Comparison of actual performance vs. mean perfor-
mance
– Comparison of actual vs. planned performance
 A framework for defining information needs and indica-
tors
• Perform a functional analysis at each manage-
ment level of the health service system
• Identify information needs and select feasible
indicators

• Patient / Client management

• Health Unit management
• Health System management
 Types of routine data collection methods
• Health unit data collection
• Community data collection
– to monitor activities performed in the community by health unit
staff or by community health workers
– to obtain more representative data on the health status and living
environment of the communities served, including data on births
and deaths in the community, agricultural and meteorological data,
data on education etc.
– to assist in planning for health services that are more accessible to
community
• Civil registration systems
 Data collection instruments
• Data collection instruments for patient/ client management

Curative Preventive
• Medical records • Growth cards
• Laboratory forms • MCH cards
• Referral forms • School health card
• Family registration records
Design & Implementation of routine data collection
systems
• How many and what type of data collection instruments will be
needed to respond adequately to the defined information needs?
• Are existing instruments adequate, or do they need to be modified?
• If new instruments are needed, how will they be developed?
• How will the new data collection instruments be introduced to the care
providers in charge of data collection?
Other issues
» Relevance
» Feasibility
» Burden
» Layout & Clarity
 Computers in MIS

• Optimization of the scarce resources available for

health care, specially in developing countries
• Information - accurate, comprehensive
• Retrieval of information - quick
• Decisions - quick
• Implementation - rapid
• Monitoring - adequate
• Large geographical area can be covered
 If computer network is established in
health organization
• More speedy communication of data
• At national, state & district levels, processing can be
done for valuable information
• Obtaining coverage levels for various activities
• Age-specific & area-specific figures
• Check suspect data from CHCs
• Identification of problems requiring research
• Prompt reporting of results
• Achieve data standards
• Data for comparative purposes
What can be done to improve and ensure data qual-
ity
• Keep the design of the information system as
simple as possible
• Involve users in the design of the system
• Standardize procedures and definitions
• Design of data collection instruments
• Develop an appropriate incentive structure
• Plan for effective checking procedures
• Training
 Data collection instruments
• Home-based records: Immunization cards, Growth-
monitoring card, Maternal health card
• Health worker based records: Pregnancy/birth card,
death report form, child records, women’s register,
workers work form
• Supervisor’s based: Supervisor’s roster
• District-based records: Family enrollment forms, birth
registers, death registers, health worker’s report, su-
pervisor’s report
• Home office- and donor-based reports of health
project outputs and population health status
Elements of Health information system manage-
ment
• Organization rules
– Data collection stan-
dards
Basic Health Ser- – Case definitions
vices HIS – Data transmission
Staff – Confidentiality
Training – Training standards
HIS Supplies HMIS
– Software design
Hardware/ Software Management
– Procurement/ Distri-
Financial Resources
bution
– Quality assurance
– Private sector

Hospital HMIS
 HMIS in context of Health Sector Reforms

• The more radical and innovative the proposed change is

in regard to the information system, the greater the im-
plications for change in the organization
• Reforms: systemic, programmatic, organizational, & in-
strumental
• The objective of producing and utilizing information more
effectively will affect the behavior and motivation of all
personnel
what is HIS?

HIS. Hospital Information System. One that supports all

hospital functions and activities such as patient records,
scheduling, administration, charge-back and billing, and of-
ten links to or includes clinical information systems such as
RIS. (Radiology Information System )
 Hospital Information System

Registration Consulting Ward Nursing

Stores & Purchase

Diet & Kitchen

Pharmacy

And more...

OT Blood Bank Laboratory Radiology

 Staff
Clinical laboratory technologist

Structure of Healthcare
Radiological technologist
Physician
professional

the Hospital Pharmacist

Nurse

Community Hospital administrator

Radiological Community

Clinical Laboratory Community

Pharmaceutical Community

Patient care Community

Outpatient Community Inpatient Community

Medical Service
Patient
Administration Community

Reception Community Medical Accounting Community

 Development steps of HIS

GMIS
Geographical Manage-
ment Information System

Clinical Informa-
tion System
CIS

Management Information
MIS System
The information in hospital
The information of the hospital come from
• Front office
• Doctors consultation room
• Ward
• Laboratory
• The service providers like financial and in-
surance service provider
• And so on
This information can be categorized as
 Information will be used by the areas

• Patient Administration
• Clinical Management
• Resource Management
• Financial Management
• Management Information System
• And more…
The function of HIS
HIS have the ability to link the following major
players

• Laboratories
• Pharmacies
• Researchers
• Doctors and consultants
• Banks and financial institutions
• Administrators
• And knowledge managers
• the aim of a HIS is
r to adequately enable the execution of information
processing functions
– for patient care, including
administration as well as
– for research and education mainly
for university hospitals -
r considering economic hospital management, as
well as
r legal and other requirements
• therefore HIS contributes to a high quality of pa-
tient care and medical research
• HIS should provide
r information, primarily about patients, in a way that it is
correct, pertinent and up to date, in time, accessible by the
right persons at the right site in a usable format
r knowledge, primarily about diseases, but also, for exam-
ple, about the effects of drug interaction, to support diagnosis
and therapy
r information about the quality of patient care, hospital per-
formance and costs
in other words:
• HIS should provide, as far as feasible,
r the right information and
r the right knowledge
r at the right time
r in the right place
r to the right people
r in the right form
• so that these people can make
r the right decisions
 ten application areas will be the necessary part
of the HIS
1. Admissions, Medical Records & Abstracting (ADM/MRI/
ABS)
2. Billing/Account Receivable (BAR)
3. Community Wide Scheduling (CWS)
4. Data Repository (DR)
5. Imaging and Therapeutic Services (ITS)
6. Laboratory, Microbiology, Blood Bank & Anatomical
Pathology (LIS)
7. Order Entry & Electronic Medical Record (OE/EMR)
8. Patient Care System (PCS)
9. Pharmacy (PHA)
10. Remote Physician Access
importance of HIS
• the information system of a hospital is an important
quality factor
• the information system of a hospital is an important
cost factor
• the quality of HIS is becoming increasingly relevant in
the competition between hospitals
• a HIS can provide a holistic view of patients and of a
hospital
• a HIS can be seen as the memory and nervous system
of a hospital
Thank you very much.
Any questions?