Integrated Health Information Architecture (IHIA)

Learning Objectives

– Health System is more than point of care– Different types of health information systems– Integrated Health Information Architecture

(IHIA) – Global movement towards IHIAs– Enablers of an IHIA

• data warehouse • Standards and interoperability

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What is health?

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What is health service quality?

Political commitment to health as a social goal Societal values of equity, political participation

and community involvement in health Investments in Primary Health Care Widespread education (women)

Societal factors contributing to health

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1) to understand and influence how the health care service delivery operates: access, coverage, continuity of care, risk assessment

2) efficient and effective service delivery

Health care resource allocation indicators (per capita): distribution of qualified health personnel

distribution and type of health services distribution of health expenditure on personnel, supplies, facilities

Health care utilization indicators: immunization coverage antenatal care coverage proportion of births attended by a skilled attendant

Health status indicators: Infant mortality rate maternal mortality life expectancy at birth prevalence/incidence of infectious diseases

Benchmarks for National Health Systems

Source: Good Health at Low Cost 25 Years onWhat make a successful health system?

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WHO Health System building blocks

Human resources

Source: Good Health at Low Cost 25 Years onWhat make a successful health system?

Countries with a Critical Shortage of Health Care Providers

N. Engl. J.Med 2007, 2564-67

Human Resource Information System (HRIS)

For the management of human resources, with data related to staff (name, profession, diplomas, salary, etc)

Functionality of the system is geared towards managing hiring, distribution, payment, education, and certification of staff, over time

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Electronic Medical Records (EMR)

- Are related to patient care, and focus on patient data (name, age, symptoms, medical history, test results etc)

- Functionality around patient care, registration symptoms, test results, medicine prescription, referrals, billing, etc.

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EMR: Support Patient workflow

Logistics Management Information Systems (LMIS)- Related to the logistical tasks around

distributing health related commodities, such as vaccines, medicines, instruments, etc

- Functionality for inventory management, ordering and procurement, tracking commodities, certifying suppliers, forecasting etc

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Health information subsystems

A National health information system consist of several subsystems

Routine data collection based on patient and service records and regular reporting from community health workers & health facilities

Disease surveillance and outbreak notification Programme-specific monitoring and evaluation

(ex: EPI, Malaria, TB, HIV/AIDS) Administration and resource management

(budget, personnel, supplies) Data generated through household surveys Registration of vital events and censuses

(births, deaths and causes of death)

Individual /program tracking

Individual /program tracking

Aggregate dataAggregate data

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Some benefits of good HIS

- providing (continuity of) care to patients (medical staff)- assist decision makers in detecting and controlling

emerging and endemic health problems- monitor progress towards health goals/targets (MDGs)- promote equity (many not counted!)- strengthening the evidence base for effective health

policies- permitting evaluation of health system interventions

over time- ensuring accountability in the way resources are used

HIS around the world

Huge differences between national health information systems (HIS), however generally a move from paper to digital and hence potential integration of systems

Common national challenges:– Little use of health information (locally)– Too much data collected – Low quality of information– Fragmentation of information streams– HIS Staffing not prioritized

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Typical national HIS setup

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Integrated Health Information Architectures (IHIAs)An overall framework for how these various information systems

work together (HMIS, EMR, HRIS, LMIS, etc)

Integrated (appearing as one)– Working together, sharing definitions and data across

information systems

Architecture– Collection of sub-systems; organized to form a whole, but

have different roles– An architecture describes roles and relationships between

systems

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IHIA as a system of systems, their roles, and relationships

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HMIS

EMRHRIS

Lab. IS

LMIS

IHIA

Why is it important with IHIAs?

To share data– powerful analysis by combining data sources– improve quality by reducing duplication and

manual transmission of data

Resource optimization– reduce duplication of data collection– reduce development and maintenance of

overlapping systems

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Example: Combining HR and clinical data

• Service delivery data comes from many sources HMIS such as DHIS2 Electronic Health Records

• Health worker deployment data comes from many sources Payroll at Ministry of Finance, HR System at Ministry of Health Licensure and Registration from councils

• Combining these two data sets across multiple systems allows new questions to be asked and answered What facility is most in need of nurse midwives? Which districts should we target training for chronic diseases? Where should we prioritize financial incentives to retain health workers?

Example: Calculating deliveries per midwife

Global Movement towards IHIA

Health Metrics Network (since 2005)– Build consensus around integrated data warehouses – provide a framework for building IHIAs– many countries have developed strategic plans to work

towards an IHIA

Donors changing approach: Paris declaration (2005) – build on local systems; local government decisions, but still

donor specific reporting requirements – collaboration between donors (harmonization), but hard to

accomplish in practice– shift funding towards evidence-based interventions, but

dependent on reliable information

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Data warehouse

- A database compiled from differerent sources, designed to process and present data for a multiplicity of users, based on their needs

- For an IHIA, a data warehouse should contain data from all the subsystems related to health, including service data, census, surveys, environmental data etc.

- Also called an integrated data repository26

The HMN model of a data warehouse - integrated data repository

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Example: combining various dataCHIEFDOM LEAGUE TABLE

2ND QUARTER APRIL – JUNE 2009

20.893.632.4114.34391.4Total

14143.228.3100.038.273.82954.9Bumpeh

12123.738.677.8101.268.02961.1Upper Banta

12123.760.5100.057.453.72671.8Ribbi

884.364.086.689.492.64049.8Kori

884.336.5100.077.693.24580.4Kargboro

884.386.5100.0140.769.73555.6Kamaje

884.332.193.092.4110.33761.4Bagruwa

664.735.6100.0120.8201.64888.3Lower Banta

664.778.2100.046.796.552118.4Kowa

334.833.091.791.7106.846140.3Timidale

334.871.375.093.4162.75590.3Kaiyamba

334.845.9100.086.390.557134.9Dasse

225.048.1100.086.2154.362124.3Fakunya

115.393.386.696.6170.94598.2Kongbora

RankingRankingAverage Score

% Exclusive Breastfeeding

at Penta3

% MMRC Submitted

% 2nd Dose of IPT

% 3rd ANC Visit

% PHU Delivery2nd

Quarter

% FullImmunized 2nd Quarter

Chiefdoms

Immunization &

population

Deliveries and

population

Antenatal & population

MalariaData Quality

Nutrition and

population

Standards and Interoperability

- Standards allows the various subsystems of an IHIA to share data– Standard data definition– Data exchange standards

- When the sub-systems can share data and work together as an IHIA, they are interoperable

More about these two concepts later in the course

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