Health Management Information

System

State Institute of Health and Family Welfare, Jaipur

 Information System


 “Comprehensive, coherent arrangement

organized on an organizational or major
program basis to collect, process and
provide coordinated information to
serve multiple needs of management
system”

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 M.I.S. ?
A two directional characteristic of information flow,
with systematically designed arrangement to -

ØGenerate
ØCollect
ØAnalyze
ØStore
ØPresent
ØMake available
required information to different managerial levels

for improved and timely decisions and actions

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 Definition
Ø MIS is a system having a combination of
persons, a set of manuals, and certain
equipments to select, store, process and
retrieve data to reduce the uncertainty in
decision making by yielding information to
managers at the time they can most efficiently
use it.
Ø ‘Service statistics’ and ‘MIS’
Øservice statistics generate data
whereas
ØMIS is on utilization of data in the
planning and control activities, in an
organization
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Essential Features of Information
System
Ø Reliable
Ø Not too much paper work
Ø Data transmission - accurate and timely
Ø Availability in disaggregated form
Ø Shortest time lag between collection and
transmission
Ø Data must be available to assess both
quantity and quality of health care
Ø Simple- recording reporting and analysis

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 HMIS- Need
Ø Increasing utilization
Ø Increasing client satisfaction
Ø Increasing health status
Ø Induction of manpower
ØProblem solving
ØResource allocation
ØRewards/Promotions
(at times for Fault finding)

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Ø HMIS does not offer
 “Ready-made” solution
•
Ø Each HMIS is
 “Tailor made” specific to an
 organization and levels within it

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Information in Health Care Delivery
is Required for

Ø Evidence based policy and strategic

decision-making
Ø Program management
Ø Monitoring the process and outcomes
Ø Evaluation of achievements

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 Use of Information in

Ø National & State Ministries for

ØAssessing impact
ØPolicy development
ØFinancial allocations


Ø Health care professionals for

ØTreatment in Hospitals/ CHC/ PHC
ØChoosing alternatives between
care
 lines
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Ø Legal bodies
ØAs documentary evidence of care
ØProtect interests of Health care

professionals and patients
Ø Insurance companies for reimbursement of
claims


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 HMIS- Purpose


Needed for
Planning

Information


Purpose
Implementation


Monitoring
 ØCost
 ØTime
ØResources
Evaluation


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Data Requirements at Different
Levels of Decision Making

.…Top level….
Quality

….Middle level….
Quantity
….Lower level….

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 HMIS- Process
 Formulated information
 (fixed)
Constraining Planning Execution
Information

(Dynamic)

 Processed
 information
 (Dynamic)

Monitoring & Control



Reports Processing Reports
 inputs
 Storage
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 Objectives of HMIS

Ø For development of strategic plan for national

health information systems
Ø For establishment of communicable and non
communicable disease surveillance
systems
Ø To promote the use of ICD-10 and to improve
data quality
Ø To establish a National health database with
indicators to monitor and assess health
outcomes
Ø
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Ø To provide technical support to strengthen
data analysis and use of information at
all levels of health care delivery
Ø To promote research
Ø To facilitate the use of scientific evidence
based on research
Ø

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 HMIS
 Data
 “Messages not evaluated for their worth
 in specific situations”
 Primary
 Secondary


Information
 “Evaluated data”
 “A resource with cost & benefit
 “Potential knowledge”
 “An essential input for decision making

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

Record
“a document of transaction between a client and

service provider containing details of who did

what to whom, when and where”, e.g.

 A bill
 A prescription
 A discharge ticket
 A laboratory report
 A register

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Sources of Data
Ø Diaries
Ø Family registers
Ø Hospital registers / Records
Ø Periodic reports
Ø Rapid surveys
Ø Exit interviews
Ø National sample survey
Ø Census
Ø Special studies
Ø
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Data: Attributes

Ø Accurate
Ø

Ø Valid
Ø

Ø Reliable
Ø

Ø Timely
Ø

Ø Complete
Ø

Ø Retrievable

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 HMIS-Application
Should Provide Support to
Ø Health Workers:
ØUnderstand health needs
ØPrioritizing clients

ØEstimate requirement
Ø Program Mangers:
ØAssess quality & Coverage
ØAllocate resources
ØReduce wastage and
duplication
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SIHFW: 20
ØPolicy makers:
ØAssess cost-effectiveness
ØDecide content & mode of
service delivery
ØDevelop norms
ØFinancial
ØInfrastructure
ØStaffing
ØLogistics

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Levels at Which We Need Information

Ø Point of entry of client into the System

Ø Point of Service
Ø Point of decision-making

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Attributes of HMIS
Ø Timeliness
Ø Accuracy
Ø Relevance
Ø Up-to-datedness
Ø Adequacy
Ø No Overloading
Ø Format Clarity
Ø No duplication
Ø Explicitness
Ø
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 HMIS- Problem Areas
Ø Unrealistic expectation of Managers
Ø Addressing to –”Report to higher levels”
rather than convincing of benefits
Ø Too much information asked
Ø Poorly trained, Over worked staff, (30-40%
time in reporting)
Ø Information-selective & to handle out of
pressure ad hoc exigencies
Ø Many reporting levels- Data lost

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Ø Performance indicators
ØShifting priorities within program
ØNew additions- NO deletions
Ø Indicators-simply output oriented
Ø Program priorities & timeliness of information
flow
Ø Retrieval
Ø Duplication
Ø NO periodic review
Ø NO feed back to initiate corrective measures

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HMIS- Components
Ø Identification
Ø

Ø Collection
Ø

Ø Classification
Ø

Ø Processing
Ø

Ø Communication
Ø

Ø Interpretation
Ø

Ø Storage
Ø

Ø Retrieval

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 HMIS- Components

5 components of the basic mgt. process in healthcare-



1.Establishing goals & Objective

2.Estimate demand for services
3.Allocate resources including manpower
to meet demands
4.Control quality
5.Evaluate performance

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Relevant health information tools for
different levels of the health system

• Source :WHO 2005

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Factors Required to Develop and
Implement HMIS:

Ø Strong political backing

Ø A culture that values and uses information
Ø Involving all levels in changes to HMIS
Ø Starting with improving the paper based
system
Ø Ensuring the feedback loop is continuous
and reliable

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 Prerequisites of HMIS

Ø Existing formats, transmission system &

channels, capacity of data handlers and
analyzers and the resources (hard and soft)
available.
Ø Exploring possibilities of additions and deletion
of parameters
Ø Complimentary or contradictory nature of sub-
systems of the System
Ø

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Basic Steps in Designing HMIS

Ø Determine organizational need for

information
Ø Identify sources of information
Ø Decide on amount, form and frequency
Ø Select means of information communication
& processing


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 Designing HMIS

1.Design Requirements:
ØClarity of Objectives
ØAwareness of information need
ØFlexibility to change


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2. Considerations in information system design


ØIdentifying & listing of objectives and norms

ØIdentification of all decision points
ØDetermination of relative importance & priority
of identified decisions
ØIdentifying information need for decision
ØIdentification of relationship among decision
sets
ØSpecification of information system
ØInstallation
ØEstablishing a review mechanism
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3. Information requirements - governed by


ØDecision structure of Program

ØLevels of decision making
ØQuestions to be answered
ØEconomics of information management,
based on these requirements decision shall
be taken regarding type of information,
which could be-
ØScientific& Technical (Related to
problem & solution
ØSituational (Program
environment)
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ØProgrammatic (Intervention
HMIS- Information Requirements
Decision structure of Program
Levels of decision making

Questions to be answered

Economics of information management

Decide the type of information, which could be-

Scientific& Technical (Related to problem &
solution)
Situational (Program environment)
Programmatic (Intervention system)

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 HMIS- Designing
Technical Requirements
Ø Data collection instrument
ØSimple
ØMinimum
Ø Develop a data flow mechanism
ØWho to generate
ØWho to consolidate
ØWhom to be sent & How (mode)
ØWhere & by whom to be analyzed
ØWho to be reported
ØFrequency of compilation, Analysis &
reporting
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 HMIS- Designing information system
Steps
ØWhat data is needed
ØWho generates in what form
ØDetermine organizational
ØQuality need for information
ØProcessing requirement ØIdentify sources of
information
ØTypes of formats for
ØDecide on amount, form
reporting and frequency
ØFrequency of reporting ØSelect means of
information communication
ØData storage system & processing
ØDevices for storage
ØWhat should be the channel
for info. flow
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 Strengths of HMIS
Ø In streamlining and standardizing of data records
Ø In creation of an integrated warehouse
Ø In collecting data from different sources
Ø conducting cross analysis
Ø Rationalizing of reporting flows
Ø Supporting customized reporting
Ø indicator based analysis
Ø integration of various software applications such
as GIS and Excel
Ø Conducting data quality validation
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 Benefits of HMIS
Ø Helping decision makers
Øto detect
Øcontrol emerging and endemic health
problems
Ømonitor progress towards health goals

Øpromote equity
Ø Empowering individuals and communities with
Øtimely and understandable health-related
information
Ødrive improvements in quality of services
Ø SIHFW: an ISO 9001: 2008 Certified Institution 40
Ø Supports Health Workers, in
ØUnderstand health needs (based on
approaches like CNAA)
ØPrioritizing clients (Estimate
requirements (based on
Demographic profile, morbidity
profile, coverage and /or

Expectations)
Ø Support Program Mangers, for
ØAssessing quality & Coverage
ØAllocating resources
ØReducing wastage and duplication
Ø SIHFW: an ISO 9001: 2008 Certified Institution 41
Ø Support Policy makers, to
ØAssess cost-effectiveness
ØDecide content & mode of service
delivery
ØDevelop norms:
ØFinancial
ØInfrastructure
ØStaffing
ØLogistics

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 Reporting Formats under
NRHM
Institutions Reporting Format
Sub centre Form No. 6
PHC Form No. 7
CHC/FRU/UFWC Form No. 8
Block level Form No. 9 A
District level Form No. 9

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 Collection of Data

Data Collection Tools
ØReporting Formats
ØOnline reporting
ØEligible Couple Survey
ØConcurrent Evaluation/
Studies
ØSurvey by different
Agencies
ØMonitoring and Validation
Exercise
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 Analyze the Data

ØBy allotted ELA/Targets

ØBy comparison of last year
progress
ØBy health indicators
ØBy annual action plan
ØBy Five Year plans
Ø
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Ø
 

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