Integrated Health Information Architecture (IHIA)

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Learning Objectives Health System is more than point of careDifferent types of health information systemsIntegrated Health Information Architecture (IHIA) Global movement towards IHIAsEnablers of an IHIAdata warehouse Standards and interoperability

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*What is health?

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*What is health service quality?

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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 assessment2)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, facilitiesHealth care utilization indicators: immunization coverage antenatal care coverage proportion of births attended by a skilled attendantHealth status indicators: Infant mortality rate maternal mortality life expectancy at birth prevalence/incidence of infectious diseases

Benchmarks for National Health Systems

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

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*WHO Health System building blocks

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Human resources

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

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Countries with a Critical Shortage of Health Care ProvidersN. Engl. J.Med 2007, 2564-67

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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

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Logistics Management Information Systems (LMIS)Related to the logistical tasks around distributing health related commodities, such as vaccines, medicines, instruments, etcFunctionality for inventory management, ordering and procurement, tracking commodities, certifying suppliers, forecasting etc*

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*Health information subsystemsA 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

Aggregate 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 problemsmonitor progress towards health goals/targets (MDGs)promote equity (many not counted!)strengthening the evidence base for effective health policiespermitting evaluation of health system interventions over timeensuring accountability in the way resources are used

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HIS around the worldHuge 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 informationFragmentation of information streamsHIS 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 systemsArchitectureCollection of sub-systems; organized to form a whole, but have different rolesAn architecture describes roles and relationships between systems

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

HMIS

EMR

HRISLab. IS

LMISIHIA

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Why is it important with IHIAs?To share datapowerful analysis by combining data sourcesimprove quality by reducing duplication and manual transmission of data

Resource optimizationreduce duplication of data collectionreduce development and maintenance of overlapping systems*

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Example: Combining HR and clinical dataService delivery data comes from many sources HMIS such as DHIS2 Electronic Health RecordsHealth 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?

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Example: Calculating deliveries per midwife

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Global Movement towards IHIAHealth Metrics Network (since 2005)Build consensus around integrated data warehouses provide a framework for building IHIAsmany countries have developed strategic plans to work towards an IHIADonors 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 practiceshift funding towards evidence-based interventions, but dependent on reliable information

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Data warehouseA database compiled from differerent sources, designed to process and present data for a multiplicity of users, based on their needsFor 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 repository*

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The HMN model of a data warehouse - integrated data repository*

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Example: combining various dataImmunization & populationDeliveries and populationAntenatal & populationMalariaData QualityNutrition and population

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Standards and Interoperability-Standards allows the various subsystems of an IHIA to share dataStandard data definitionData exchange standards-When the sub-systems can share data and work together as an IHIA, they are interoperableMore about these two concepts later in the course*

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Example from Malawi: Headcount vs NSO****