Unit Five

Health Management Information

System (HMIS)

Learning objectives
At the end of this unit, the learner will be
able to;
1.Define HMIS
2.Describe deficits of HMIS in Ethiopia
3.List elements of HMIS
4.Explain indicators of HMIS
5.Discus the steps of developing HMIS
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Basic concepts

System: A collection of components that work

together to achieve a common objective
Health System: All the activities whose primary
purpose is to promote, restore or maintain
health.
Information: Meaningful collection of facts or
data.
Information System: A system that provides
information support to the decision-making
process at each level of an organization
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Basic concepts

Health Information System: A system that

integrates data collection, processing, reporting,
and use of the information necessary for
improving health service effectiveness and
efficiency through better management at all levels
of health services
Management information system: A formal
method of making available accurate and timely
information to management that is necessary to
facilitate the decision- making process and enable
the organizations planning, control and
operational functions to be carried out effectively.
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Basic concepts

Health Management Information System: It

is an application of the principles of
management information system in health care
systems. Or an information system specially
designed to assist in the management and
planning of health programmes, as opposed to
delivery of care

Why health information system?

Good management is a prerequisite for

increasing the efficiency 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 center.
The system provides information on past,
present and projected future & relevant events
inside and outside the organization.

Why health information system?...

It is required by policymakers, managers,

health care providers, community health
workers.
Changing the way information is gathered,
processed, and used for decision-making
implies changing the way an organization
operates.

Why health information system?...

With the widespread computerization of

health records and other information sources,
including hospital administration
functions and health human resources
information, health informatics and health
information technology are being increasingly
utilized in information management practices
in the health care sector.

Health information management

professionals

Plan information systems, develop health policy,

and identify current and future information needs.
Apply the science of informatics to the collection,
storage, use, and transmission of information to
meet the legal, professional, ethical and
administrative records-keeping requirements of
health care delivery.
Work with clinical, epidemiological, demographic,
financial, reference, and coded healthcare data.

Evolution

In the past, mostly informal.

Present, electronic data processing (EDP)
use of computers in information management
(computer based information system).
Now called MIS.

HMIS in developing countries

Information system procedures were not intentionally

planned to provide management support in an integrated
way
Too much emphasis was given (placed) on the measurement
of impacts which called for costly assessment
Many decisions on policy, planning and resource allocation
are made without analysis of the information that is readily
available
The data received are often incomplete, inaccurate, untimely,
obsolete, and unrelated to priority tasks and functions of the
local health personnel
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HMIS in Ethiopia

The RHBs are primary institutions responsible for

the health service delivery.
Capacity for effective health management at all
levels remains to be low.
There is major concern regarding the HMIS.
Timeliness and completeness of the system
reporting are among the major weaknesses of the
system.
Progresses are also observed in some regions.

HMIS in Ethiopia

The RHB of SNNP has developed reporting

formats and a reference guideline for health
workers in the region with collaboration between
the RHB, Regional government, and the
ESHE/JST project funded by USAID.
This guideline consists of standard data collection
formats, standard information presentation
instruments; such as charts and tables to be
followed by the health workers and other pertinent
information on the subject.
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HMIS in Ethiopia

The Tigray RHB has also conducted similar

efforts.
Initiatives are also under process to prepare
National Management Health Information
System Strategy by the Planning and
Programming Department (PPD) of the
FMOH (PPD, 2003).

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Deficiencies of HMIS in Ethiopia

Considering the problems experienced by

many developing countries, the HMIS in
Ethiopia seems not to be different from other
developing countries.
Preliminary assessment of NHMIS and
experiences of some regions (SNNR); the
current HMIS showed that it has the following
major deficiencies.
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Deficiencies of HMIS in Ethiopia

In general, the current HMIS is inadequate in

providing the required information for
management support.
Hence, data coming from the system is not a
resourceful input for decision making.
There is considerable underutilization of the
information generated by the system for decision
making at all levels specially in the front line where
the data is collected and information is generated.
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Factors attributed to deficient HMIS in

Ethiopia

The data quality is considered to be very poor

Outputs of HMIS are not related to the priority
tasks and functions of the local health personnel
Lack of technical knowledge and skill of data
collectors at the lower level
Lack of uniformity and consistency in definitions.
Outdated ICD
Considerable limitation of financial and material
resources
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What is wrong with current HMIS?

Irrelevance of the information gathered

Poor quality of data
Duplication and waste among parallel health
information 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.
(WHO 2000, Regional Office for Africa, 2004).

Constraints with current HMIS

Limited funding
Deficiency in information infrastructure
The network is still vulnerable to external shock
caused by virus, repair and /or replacement delays,
difficult system codes etc.
Significant underutilization of data / information for
decision making
Lack of interest or / and experience of use of
information by managers
Inadequate human resource, lack of expertise

Whats the HMIS objective?

Ensuring the quality of all health data.

Strengthening the ability to analyze and use
the data.
Making informed and cohesive decisions can
and will positively affect the health and lives
of the people.
Planning, organizing, leading, controlling and
decision-making.

Elements of HMIS

Training standards
Software design
Procurement/
Distribution
Quality assurance
Private sector

Organization rules
Data collection
standards
Case definitions
Data transmission
Confidentiality

Factors to evaluate information received

1. Information quality accuracy and reliability.
2. Information timeliness before deviations
occur.
3. Information quantity Just sufficient.
4. Information relevance related tasks and
responsibilities.

Design of HMIS

Desired characteristics of information in

health services
Relevance
Accuracy
Completeness
Timeliness
Conciseness

Sources of Information System

o

o
o

Health institutions (inpatient/outpatient and

other activities)
Vital registration systems (births, deaths, and
migratory movements)
Laboratories and pharmaceuticals
Community

Sources of Information System

o
o

Census
Special programmes reporting systems
(tuberculosis and leprosy control, MCH,
school health)
Administrative systems (health care financing
systems, health personnel systems, logistic
systems)

Sources of Information System

Investigation of outbreaks
Surveys and surveillances
Diseases notifications
Routine reports
Which of the above sources are computerized?
o

Each source has its own advantages and

limitations.

A framework for defining information needs

and indicators

Perform a functional analysis at each

management level of the health service
system.
Identify information needs and select feasible
indicators
Indicators are variables that help to measure
changes, directly or indirectly (WHO).

A framework for defining information needs

and indicators
Indicators are important to:
To analyze present situation
To make comparisons
To measure trends
Most health indicators are quantitative
(numbers)

Helpful questions in selecting good

indicators

What is the indicator supposed to measure

(validity)?
What will be the cost of measuring the data
to arrive at the numerator and denominator of
the indicator?
Is the change shown by the indicator a true
change in the situation under study.

Helpful questions in selecting good

indicators

What is the relative importance of the subject

matter to be addressed and the decision to
be made based on the indicator (relevance)?
Does the indicator actually capture the
changes that occur in the situation under
study (specificity)?

Types of Indicators

Health policy
Social and Economic Development Indicators
Population changes
Provision of health care
Health Status (nutritional, morbidity, mortality)

Information is collected, analyzed, presented

and communicated.

Steps in Developing a HMIS

(1) Review the existing system
(2) Define the data needs of relevant units
within the health system
(3) Determine the most appropriate and
effective data flow
(4) Design the data collection and reporting
tools
(5) Develop the procedures and mechanisms
for data processing

Steps in Developing a HMIS

(6) Develop and implement a training
programme for data providers and data users
(7) Pre-test, and if necessary, redesign the
system for data collection, data flow, data
processing and data utilization
(8) Monitor and evaluate the system
(9) Develop effective data dissemination and
feedback mechanisms
(10) Enhance the HMIS

Steps involved in restructuring of HMIS

Step 1: Identifying information needs and

feasible indicators
Step 2: Defining data sources and
developing data collection instruments for
each of the indicators selected
Step 3: Developing a data transmission
and processing system

Steps involved in restructuring of HMIS

Step 4: Ensuring use of the information
generated
Step 5: Planning for HMIS resources
Step 6: Developing a set of organizational rules
for health information system management
(WHO, 2000)

Key issues of HMIS

Movement of data through out the system

Accessibility and analyzability of data
Transmission of finding to potential users

Tasks of HMIS

Filing and storing

Compiling
Analyzing

Types of reports

Operational: detailed
Technical: mentoring and evaluation
Strategic: to justify priorities and decisions

Managing the flow of data

Impose strict timetable at each level.

Ensure two-way flow.
Establish regular cycle of analysis and
feedback.

Data collection instruments

1. Data collection instruments for patient/ client
management
A. Curative
Medical records
Laboratory forms
Referral forms

Data collection instruments

B. Preventive
Growth cards
MCH cards
School health card
Family registration records

Data collection instruments

2. Data collection instruments for health unit
management
A. Service delivery records.
Registers
Tally sheets (Abstract register
Population charts
B. Resource Management records

Strategies for MIS Development

Plan carefully for modification of existing

system establishing new.
Change attitudes to information gathering
processing and utilization.
Participate staff in HMIS.
Provide training for utilizing HIS

Computer applications in health service

delivery
1. Clinical information systems
2. Administrative information systems

Computer applications in health service

delivery
How to decide on need for a computer?
o Technical feasibility
o Operational feasibility
o Economic feasibility

Computer applications in health service

delivery

How to introduce micro computers

o Choose software
o Choose computer
o Assess the physical environment
o Assess the organizational environment

Computer applications in health service

delivery
o
o
o
o
o

Train personnel to use computers

Social behavior
Training for managers
Training for problem solving
Define role of computer in work
environment