L4-7

• Health Information Technology

  ✓ “The area of IT involving the design,

  development, creation, use, and maintenance of

  information systems for the healthcare industry.

  Automated and interoperable healthcare

  information systems are expected to improve

  medical care, lower costs, increase efficiency,

  reduce error and improve patient satisfaction"

  Rouse (2016)

  ✓ Health information technology promises to

  modernize and streamline healthcare and to

  connect different users and stakeholders in the

  e-health market. (Kushniruk and Borycki, 2017)
• Health Care Software Systems

  Electronic Health Record (EHR)

  ✓ It is a person's official, digital health record and

  is shared among multiple healthcare providers

  and agencies

  ✓ Personal Health Record (PHR): person's self-

  maintained health record

  ✓ Health Information Exchange (HIE): a health

  data clearinghouse which is comprised of healthcare organizations that enter into an

  interoperability pact and agree to share data

  between their various health IT systems
• Picture Archiving and Communication Systems (PACS)

  and Vendor Neutral Archives (VNAs)

  ✓ two widely used types of health IT that help

  healthcare professionals store and manage

  patients' medical images

  ✓ VNAs can also be for the purpose of merging

  imaging data from various departments into a

  multi-facility health care system.

  ✓ radiology departments have been the primary

  repositories of medical images, presently,

  cardiology and neurology have also become

  large-scale producers of clinical images
• Health Information Ecosystem

  ✓ A composition individuals, systems and

  processes that want to share, exchange, and

  access all forms of health information, including

  discrete, narrative and multimedia (The

  Healthcare Information and Management

  Systems Society, 2017)

  ✓ An efficient health interoperability ecosystem

  provides an information infrastructure that uses

  technical standards, policies and protocols to

  enable seamless and secure capture, discovery,

  exchange and utilization of health information
• Health Informatics in the Cloud

  Currently, 83% of healthcare organizations are

  making use of cloud-based applications, and it is

  changing the landscape of the healthcare system and

  health informatics (University of Illinois, 2014).
• Health Informatics in the Philippines

  Community Health Information Tracking System

  (CHITS)

  ✓ an electronic medical record (EMR) developed

  through the collaboration of the Information

  and Communication Technology community

  and health workers, primarily designed for use

  in Philippine health centers in disadvantaged

  areas ✓ It is currently utilized in 111 government health

  facilities

  ✓ OTHERS: Linux, Apache, MySQL, PHP-based

  system released under the general public

  license (GPL)
• The electronic health record (EHR) is the

  central component of the health IT

  infrastructure.
• Health Information System refers to any

  system that “captures, stores, manages or transmits

  information related to the health of individuals or the

  activities of organizations that work within the health

  sector.”
• Health Information Systems (HIS)


  • Files are easier to access
  • Only authorized staff can access the information of the patient
  • Doctors may have permission to update, change and delete information from the electronic medical record
  • The receptionist, however, may only have the authority to update a patient's appointments
  • Health information systems let doctors create electronic medical records for their patients
  • Patient information can be pulled up for review at any time and copies can be made for the patient upon request
  • Health information systems abet communication between multiple doctors or hospitals
  • Medical professionals must pay close attention to confidentiality issues, such as patient privacy and security safeguards to ensure unauthorized users cannot access the information
• The days of hard files and loose papers are over
• Health information systems are electronic
• Indicators

  A core set of

  indicators and related

  targets is the basis for a

  health information

  system plan and strategy.

  Indicators need to

  encompass determinants

  of health; health system

  inputs, outputs and

  outcomes; and health

  status
• Data Sources

  These can be divided

  into two main categories:

  ✓ Population-based

  approaches

  (censuses, civil

  registration and

  population

  surveys)

  ✓ Institution-based

  data (individual

  records, service

  records and

  resource records
• Data Management

  This covers all aspects

  of data handling from

  collection, storage,

  quality-assurance and

  flow, to processing,

  compilation and analysis
• Information Products

  Data must be

  transformed into

  information that will

  become the basis for

  evidence and knowledge

  to shape health action
• ✓ consist of facts such as age (or birth date),

  gender, race and ethnic origin, marital status,

  address of residence, names of and other

  information about immediate family members,

  and emergency information. Information about

  employment status (and employer), schooling

  and education.

  Demographic data
•  involves facts, with respect to services provided

  (e.g., diagnostic tests or outpatient procedures),

  and also typically include charges and amounts

  paid, the kind of practitioner (physician,

  podiatrist, psychologist), physician specialty,

  and nature of institution (general or specialty

  hospital, physician office or clinic, home care

  agency, nursing home, and so forth).

  Administrative data
• ✓ reveals lifestyle and behavior (e.g., whether an

  individual uses tobacco products or engages

  regularly in strenuous exercise)

  ✓ facts about family history and genetic factors to

  evaluate patient’s propensity for different

  diseases.

  Health Risk Information
• is generally reported by individuals themselves,

  reflects domains of health such as physical

  functioning, mental and emotional well-being,

  cognitive functioning, social and role functioning, and perceptions of one's health in the past, present, and future and compared

  with that of one's peers.

  Health Status
• ✓ considers data on previous medical encounters

  such as hospital admissions, surgical

  procedures, pregnancies and live births, and the

  like

  ✓ it also includes information on past medical

  problems and possibly family history or events

  (e.g., alcoholism or parental divorce).

  Patient Medical History
• ✓ includes the content of encounter forms or

  parts of the patient record. Such information

  might reflect health screening, current health

  problems and diagnoses, allergies (especially

  those to medications), diagnostic or therapeutic

  procedures performed, laboratory tests carried

  out, medications prescribed, and counseling

  provided.

  Current Medical Management
• Outcomes data

  ✓ comprise a wide array of measures of the

  effects of health care and the aftermath of

  various health problems

  ✓ they might reflect health care events such as re-

  admission to hospital or unexpected

  complications or side effects of care, and also

  include measures of satisfaction with care.

  ✓ outcomes assessed weeks or months after

  health care events, and by means of reports

  directly from individuals (or family members),

  are desirable, although these are likely to be the

  least commonly available (Donaldson and Lohr,

  1994).
• In a nutshell, the problems faced by hospitals using the

  traditional manual process included:

  ✓ No real time data available to monitor the

  performance of the hospital

  ✓ Evidence based program management was a

  challenge

  ✓ Undue delays in receipt of data

  ✓ Retrieval of old manual records was ineffective

  and time consuming.

  ✓ Duplication of records

  ✓ Monthly reports sent as hard copy which is a

  real challenge for data analysis/comparison

  ✓ Drug inventory/equipment inventory

  maintenance.

  ✓ Lack of standard names and code
• Health Management Information System

  ✓ An information system specially designed to

  assist in the management and planning of

  health programs, as opposed to delivery of care.

  (World Health Organization, 2004)

  ✓ It is a routine-monitoring system that monitors

  and evaluates the process with the intention of

  providing warning signals through the use of

  indicators.
• ✓ The major role of HMIS is to provide quality

  information to support decision-making at all

  levels of the health care system in any medical

  institution.

  ✓ It also aims to aid in the setting of performance

  targets at all levels of health service delivery

  and to assist in assessing performance at all

  levels of the Health Sector (Ministry of Health,

  2010)
• Health Management Information System

  • Complete
  • Consistent
  • Clear
  • Simple
  • Accessible
  • Confidential
  • Cost Effective
• Complete


  Provide information on all key aspects of the health system without duplication
• Consistent


  If similar information is provided by different sources, their definitions need to be consistent
• Clear


  It should be very clear what all the elements are actually measuring
• Simple


  It should not be unnecessarily complicated
• Accessible


  Data should be held in a form readily accessible to all legitimate users, and it should be clear who these people are
• Confidential


  It should ensure that people without legitimate access are effectively denied
• Cost Effective


  The actual usage of each element should justify the costs of its collection and analysis
•  This involves both the generation and the

  collection of accurate, timely, and relevant

  data. In HMIS, this is normally achieved

  through the input of standard coded

  formats (e.g., the use of bar codes) to

  facilitate the rapid mechanical reading and

  capturing of data.

  Data Acquisition
• Involves the authentication and validation

  of gathered data. The quality of collected

  data depends largely on the authority,

  validity, and reliability of the data sources.

  Data Verification
• The preservation and archival of data may

  be regarded as part of the data storage

  function. When accumulated data are no

  longer actively used in the system, a

  method to archive the data for a certain

  period is usually advisable and may

  sometimes be mandatory, as when it is

  required by legislation.

  Data Storage
• This is also known as Data Organization. It

  is a critical function for increasing the

  efficiency of the system when the need

  arises to conduct a data search. Most data

  classification schemes are based on the use

  of certain key parameters. For example,

  data referring to a patient population may

  be classified and sorted according to various

  diagnostic classification schemes.

  Data Classification
• ✓ Involves various forms of data manipulation

  and data transformation, such as the use of

  mathematical models, statistical and

  probabilistic approaches, linear and

  nonlinear transformation, and other data

  analytic processes.

  ✓ It allows further data analysis, synthesis,

  and evaluation so that data can be used for

  strategic decision-making purposes other

  than tactical and/or operational use.

  Data Computation
• New and changing information is accounted

  for through the element of data update.

  The dynamic nature of such data

  modification calls for constant monitoring.

  For HMIS to maintain current data,

  mechanisms must be put in place for

  updating changes in the face of any ongoing

  manual or automated transactions.

  Data Update
• ✓ Concerned with the processes of data

  transfer and data distribution. The data

  transfer process is constrained by the time

  it takes to transmit the required data from

  the source to the appropriate end-user.

  Data Retrieval