THE UNIVERSITY OF ZAMBIA

SCHOOL OF NURSING SCIENCES

MASTERS

COURSE CODE: NRS 6080

MANAGEMENT AND LEADERSHIP

ASSIGNMENT: HEALTH INFORMATION SYSTEMS

QUESTIONS:

1. What are the health care information system standards?

2. Describe the type of health information kept in health institutions

GROUP 4 MEMBERS: COMPUTER NUMBER

Joyce Namalongo 2016 145042

Ruth Zulu 2017013616

Francesca K.Milumbe 2017013601

Webby Silwaba 2017013591

Michael M Kanyanta 2017013575

Elias Tembo 2017013621

RabanChibeka 2016144879

LECTURER; Prof M.Maimbolwa

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INTRODUCTION

Quality and reliable information is the basis of decision-making across all health system building
blocks. It is essential for health system policy development and implementation, governance and
regulation, health research, human resources development, health education and training, service
delivery and financing. The health information system facilitates decision-making through the
four key functions thus: data generation, compilation, analysis and synthesis, communication and
use (MOH, 2008).

Health information system is vital in nursing and nursing management especially with the
current trends. It enables accurate decision making and provision of quality nursing care to
patients which is evidence based (Vati, 2013). Nurses and Nurse managers need to become
computer literate to enable them be versed in the dynamics of nursing information by collecting,
managing, and processing data into information and knowledge hence provision of evidence
based patient care. Knowledge of electronic health information system assists managers to access
actual patient information, reduces errors and makes them competent in their work (Harrison and
Palacio, 2006). From a policy perspective, the electronic medical record provides an opportunity
for integration of patient information and improves efficiency and quality of care across a wide
range of patient populations.

DEFINITION OF TERMS

Information

Information is data that has been put into a meaningful and useful context and communicated to
a recipient who uses it to make decisions, (Vati, 2013).

System

A system is defined as a set of related components, activities, processes and human beings
interacting together so as to accomplish some common objectives, (Vati, 2013).

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Health Information system

Health Information System (HIS) is “a system that provides specific information support to the
decision-making process at each level of an organization (USAID, 2010).

Standard

Something used as a measure, norm or model in comparative evaluations. A required or agreed

level of quality or attainment (Soanes and Stevenson, 2007).

HEALTH CARE INFORMATION SYSTEM STANDARDS

In the context of health care, the information system standards encompasses methods, protocols
terminologies and specifications for the collection, exchange, storage and retrieval of
information associated with health care applications. These include medical records,
medications, radiological images, payment and reimbursement, medical devices, monitoring
systems and administrative processes (Hammond, 2002). Health information system is one of
the essential and interrelated building blocks of a health care system (Mutale, et al, 2013). A
well-functioning HIS should produce reliable and timely information on health determinants,
health status, and health system performance, and be capable of analyzing this information to
guide activities across all other health system building blocks (ibid). According to MOH 2008,
quality health care information should conform to the following standards:

1. Relevance

Relevance of health care information implies that the information should be useful for decision
making and applicable to the situation at hand. For example, in the case of maternal deaths, the
information provided should encompass all data needed for decision making such as the major
causes of maternal deaths and nature of the case (referred or not). This will guide the managers
in analyzing the case further leading to generation of solutions. If the information system reveals
that the cause of the deaths is Post-Partum Hemorrhage, the decision makers (nurse managers)
will be able to make a decision based on the gaps identified. Decisions might include measures
such as formulation of protocols or mentorship.

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 2. Timeliness

Information should be communicated in time so that the receiver of information has enough
time to decide appropriate actions based on the information received. Timeliness refers to the
currency of the information presented to the users. Currency of data or information is the time
gap between the occurrence of an event and the reporting period. For example the MOH standard
schedule for submission of reports is weekly, monthly and quarterly. This has been made
possible by the availability of information communication technology. If information is not
submitted timely, action will be delayed or made impossible.

3. Completeness

Information should be complete both in geographical coverage and in terms of range/amount of

data it is supposed to provide. Completeness means that facts and figures should not be missing
or concealed. No data should be missing so that the decision maker can have a clear and
complete picture of the situation being reported. Incomplete information compromises reliability.
For example, if maternal deaths are reported without specification of the causes, managers
cannot take corrective actions because the causes (practice gaps) are not known. Furthermore, all
forms starting from the patient’s record cards, registers, tally sheets, activity sheets and HIA
tools must be filled in without leaving any gaps.

4. Validity

Validity implies that health information should provide the information that it is supposed to
provide. It is synonymous with accuracy of information. Validity can also mean the extent to
which the information possesses the quality of being sound or true as far as can be judged. For
HMIS data, the various forms can be checked for validity. For example, on HIA tools, if a
maternal death due to Post-Partum Hemorrhage has been reported yet tallied under infectious
conditions, it renders the information invalid. Regarding Medical records, Health Professions
Council of Zambia (HPCZ) has set a standard that medical records must keep track of all
changes or alterations so that the original entry can be visible. This is one way of ensuring
validity.

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 5. Reliable

This means that the information is consistent. If the reported information is followed up by other
persons, the same outcomes should be reported. For example if information on a tally sheet
indicates 100 cases of malaria, the same number should be replicated or replicable on other tools
such as collation sheets. Reliable information will the manager to be cost effective in planning
for actions.

TYPES OF HEALTH INFORMATION KEPT IN HEALTH INSTITUTIONS

Information is data that have been put into a meaningful and useful context and communicated to
a recipient who uses it to make decisions (Vati, 2013). Various types of information are kept in
health institutions as records or reports using various systems. According to USAID, 2010, the
type of information kept in health institutions can be categorized based on the various health
system management functions into the following:

1. Patient /Client management information

This is information needed for managing an individual client/patient. It is maintained through

patient health records. Health records are the operational record of multidisciplinary and clinical
information that accompanies a patient when they attend or are admitted to hospital (National
Health Service Trust, 2012). According to MoH, 2008 records of health services include
Patient/Client Record and Service Registers

a) Patient/Client Record

This is a book or card that keeps patient/client information including the identity, history,
diagnoses and/or service provided. Depending on the service, the patient/client record may be
kept at the facility or by the patient/client. Common practice is that curative patient records
except for chronic illnesses are kept at the health facility while preventive client records are kept
by the client. Records can be further grouped into outpatient and inpatient records. Out patient
records include; Antenatal card, TB card, Children’s Under 5 Card and many others. Inpatient
records include; In-Patient Admission Form, Partogram, Treatment Sheet, Nursing Care Charts
and many others.

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The HPCZ has set the following standards for quality record keeping

1. A health facility should have a policy for creation, management, handling,

confidentiality, storage and destruction of all records in accordance with data protection
legislation.
2. Duration of record keeping: Any records that are required to be kept under legislation are
retained for the relevant periods prescribed in the legislation
3. Destruction: Destruction of records is undertaken securely
4. Minimum patients data sets are kept in line with key performance indicators as required
by relevant authorities and stakeholders
5. Relevant staff has received training and information on medical records management to
be familiar with records management.
6. All relevant medical information is kept in medical records of each patient. This includes
at least medical conclusions, laboratory results, radiology results and other relevant
results
b) Registers

Registers are books in which the patient/client details and services being provided are recorded
Each line in the register represents a client contact and/or service provided. The registers are
used for continuity of care, follow ups and validation of data submitted to the District Office.
Furthermore, if the patient loses their card/book, the register is used to reconstruct the health
information when a replacement card/book is issued (MOH, 2008). The following are some of
the registers kept:

 Out-Patient Department Register

This register is used to record data on a single clinical encounter, hence it is said to be transverse.
It provides morbidity data for the facility as well as data for self-assessment and supervision.
Both New attendances and Re-Attendances are captured.

 In-Patient Register

This register is used to record data on a single clinical encounter, hence it is said to be transverse.
The register captures information on admissions, discharges and out comes such as death and

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referrals. It provides morbidity and mortality data for the facility as well as data for self-
assessment and supervision.

 Safe Motherhood Register

This register is used to record series of encounters with a single client related to a specific state
which in this case is pregnancy and childhood. Hence it is said to be longitudinal. It is used to
record observations, antenatal and postnatal services provided during the course of pregnancy. It
serves as a checklist of risk pregnancies as well as providing data for self-assessment.

 Delivery Register

This register is used to record data on a single clinical encounter, hence it is said to be transverse.
It records the progress and outcome of delivery. It provides data for deliveries attended by a
trained health worker, facility delivery data and data for self-assessment.

 Child Health Register

This register is used to record series encounters with a single client related to a specific state
which in this case is childhood. Hence it is said to be longitudinal. The register is used to record
immunizations, growth data and supplementations for children under 5 years of age. It serves as
facility-based record of immunizations and growth monitoring; supports follow up of children
and provide data for self-assessment.

 Family Planning Register.

This register is used to record series encounters with a single client related to a specific condition
for example pregnancy or childhood. Hence it is said to be longitudinal. It provides record of
contraceptive distribution and consultation to clients for a period of 3 years. It serves as a
facility-based record of family planning services and counselling provided; supports follow up of
dropouts and furnish data for self-assessment.

2. Health Unit/facility management information

This is information required for executing the broad management functions carried out in a
hospital ( USAID, 2010). These functions may include Management of services, Management of

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resources such as; Human resource, Finance, Logistics, medicines, equipment and capital assets
for future needs and emergencies. Therefore, the type of health information kept in this regard
includes:

 Information on health service performance and coverage for promotion, preventive and
curative services:This includes information such as Percent of mothers immunized, Bed
occupancy rate, Average daily Out Patient Department (OPD) attendance, number of
under 5 children treated for malnutrition and Percent of pregnant women delivered at
health facility.
 Information on disease and health conditions: This includes information such as number
of diarrhea cases attending OPD, number of severe pneumonia cases admitted in hospital
and others.
 Information of health resources: This includes information on Assets , Finance, Human
Resources, Logistics, Laboratory and Blood Bank

3. Health System Management Information

This is information needed by the policy makers, planners and top level managers. It includes
information on morbidity, mortality, coverage of essential services, Births and deaths, Health
behavior, Health resources, Health needs of the population, Health emergencies as well as
emerging and re-emerging disease. It is mostly captured through aggregation tools and reports.
Aggregation tools include Activity Sheets/Collation sheets and/or Tally sheets while reporting
tools include the various HIA forms (MOH, 2008).

A) Aggregation tools
i. Tally sheets

Tally sheets consisting of groupings of “0” (zeroes) are used to count elementsdefined on the
sheet such as attendance by crossing a zero for every occurrence.At the end of a given period
may be a day, month or quarter, the crossed zeros arecounted and thus provide a tally of what
was being counted.

ii. Activity sheets

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The activity sheet combines the functions of the register and of the tally sheet in one while
providing accounting for each health worker’s effort (MOH, 2008). The services and items to be
tracked are pre-defined on the activity sheet. The health worker simply provides the patient/client
reference and ticks the service provided. The ticks provide a record of the service provided and a
count of the items to be tallied at the end of the period.

iii. Collation Sheet

The Collation sheet provides a means to summarize the inputs from tally sheets or activity
sheets. The use of the collation sheet is optional as it is possible to add up entries from tally
sheets and/or activity sheets directly into the HIA (MOH, 2008).

B) Reporting tools

A Report is a written or spoken description of what you have seen, heard or done (Vati, 2013).
HIA forms are the most widely used reporting tools under health systems management.

Health Information Aggregation (HIA) forms

The Health Information Aggregation (HIA) form or report provides a pre-determined set of data
elements whose values are derived from the tally sheets, activity sheets and/or collation sheets.
Currently, the HMIS provides for three main HIA reports, namely; Service, Disease and Hospital
HIAs. The HIA is used to transmit facility aggregated data for posting into the District Health
Information System (DHIS) at the district office or at the facility where DHIS is installed.

For example Ministry of Health designed various forms for reporting such as the Disease
Aggregation Form (HIA.1) is used to map disease trends and calculating indicators. The
Hospital/Health Centre Service Delivery Aggregation Form (HIA.2) is used to provide a
summary of information on services provided offered by the institution in its areas of operation
such as the Out-Patient, In-Patient, MCH and Pharmacy Departments.

CONCLUSION

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REFERENCES

Freeman, R.B. and Heinrich, J. (1981).Community Health Nursing Practice, Saunders

Company, London

Hammond L (2002).Health Information System Standards, available at

https://www.nap.edu/read/10863/chapter/7#135 Accesses on [23/11/2017]

Harrison JP and Palacio C, (2006).The role of clinical information systems in health care
quality improvement, accessed at https://www.ncbi.nlm.nih.gov/pubmed/16905990 on
22/11/17. Accessed on [22/11/2017]

Ministry of Health (MOH)(2008). Health Management Information Systems Procedure

ManualPrimary Health Care, Lusaka, MOH

Mutale W, Chintu N, Amoroso C, Awoonor-Williams K, Phillips J, Baynes C (2013) Improving

health information systems for decision making across five sub-Saharan African countries:
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10.1186/1472-6963-13-S2-S9.PubMed, Available online at
https://www.ncbi.nlm.nih.gov/pubmed/23819699 Accessed on 23/11/17

Soanes, C and Stevenson, A(2007).Concise Oxford English Dictionary, 11th edition. London,
Oxford Press.

United States Agency for International Development (USAID) (2010).Health Management

Information System (HMIS) Facilitator’s Guide for Training of Trainers Available at

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www.who.int/healthinfo/statistics/.../EN_PDF_Toolkit_HSS_InformationSystems.pdf .Accessed
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Vati, J (2013) Principle and Practices of Nursing Mangagement and Administration for BSc
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