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Ms. Ymnas Tibaldo RMT ASCP (i)

Lesson 5 – Health Information Systems LABORATORY INFORMATION SYSTEM

Health Information Technology • Healthcare software solution that processes,

stores, and manages patient data related to
- Refers to the electronic systems health care
laboratory processes and testing
professionals use to store, share, and analyze health
information Patient Administration Systems (PAS)

Health Informatics • Captures, stores and manages essential patient

details including name, address, date of birth, and
- Practice of acquiring, studying and managing health
comprehensive records of a patient's interactions
data and applying medical concepts in conjunction with
with the hospital, across both outpatient and
health information technology systems to help clinicians
inpatient services
provide better healthcare
Human Resource Management Information Systems
Health Information Management
• Software solution that is used to collect, manage,
- Discipline that involves managing and using
store, and process an organization’s employee
patient health info. Includes ensuring the accuracy,
information
accessibility, privacy and security of patient records
across different health care settings. HRIS software
Health informatics is the application of both technology • stores, processes and manages employee data ,
and systems in a healthcare setting. including names, addresses, national IDs or Social
Security numbers, visa or work permit information
Health Information Technology focuses on tools,
and information about dependents.
programs, and storage of data.
• It typically also provides HR functions such as
Health Information Systems cover the records, coding, recruiting, applicant tracking, time and attendance
documentation, and administration of patient and management, performance appraisals and benefits
ancillary services. administration.

Health information systems refer to any system that Utilization of Health Information Systems
“captures, stores, manages or transmits information
– Collection (decision-making)
related to the health of individuals or the activities of
organizations that work within the health sector.” – Processing (policy)
– Report (program action)
This definition encompasses: – Use (individual and public health actions and research)

1. district level routine information systems, Role and Function of Health Information Systems
2. disease surveillance systems,
3. laboratory information systems, 1. Files Are Easier to Access
4. hospital patient administration systems (PAS) - Health information systems have revolutionized the
5. human resource management information way that doctors and health care professionals maintain
systems (HRMIS). patient information.
DISEASE SURVEILLANCE - These systems are electronic, so the days of hard files
• Disease surveillance is an ongoing process that and loose papers are over.
involves the systematic collection, analysis, 2. More Controls
interpretation, and dissemination of information
regarding the occurrence of diseases in defined A. Staff must be authorized to access the health
populations for public health action to reduce information system.
morbidity and mortality. B. Doctors may have permission to update,
• Community or Institutional settings change and delete information from the
electronic medical record.
C. Receptionist, however, may only have the
authority to update a patient’s appointments.

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3. Easy to Update 3. Data Sources

Health information systems let doctors create electronic These can be divided into two main categories;
medical records for their patients. Patient information
can be pulled up for review at any time and copies (1) Population-based approaches
can be made for the patient upon request. • Generate data on all individuals within
4. Communication defined populations and can include total
population counts (censuses, civil registration)
Health information systems support communication and data on representative populations or
between multiple doctors or hospitals. According to subpopulations (such as household and other
Government Health IT, medical professionals must pay population surveys)
close attention to confidentiality issues, such as
patient privacy and security safeguards to ensure (2) Institution-based data
unauthorized users cannot access the information. • Generate data as a result of administrative and
The Health Metrics Network (HMN) operational activities (individual records,
service records and resource records).
- Launched in 2005 to help countries and other partners
improve global health by strengthening the systems that 4. Data Management
generate health-related information for evidence-based
decision-making. - This covers all aspects of data handling from
collection, storage, quality-assurance and flow, to
- HMN is the first global health partnership that processing, compilation and analysis
focuses on two core requirements of health system
strengthening in low and low-middle income countries. 5. Information Products

GOALS: - Data must be transformed into information that will

become the basis for evidence and knowledge to shape
• Entire health information and statistical systems, health action
rather than focus only upon specific diseases.
• To concentrate efforts on strengthening country 6. Dissemination and Use
leadership for health information production and - The value of health information is enhanced by
use. making it readily accessible to decision-makers and by
Six Components of Health Information Systems providing incentives for, or otherwise facilitating,
information use.
1. Health Information Systems Resources
In addition to the six components, the HMN also further
These include the legislative, regulatory and planning subdivides an HIS into inputs, processes, and
frameworks required for a fully functioning health outputs.
information system, and the resources that are required
for such a system to be functional includes: Inputs:

A. Personnel - Policy
B. Financing - Financing
C. Logistics support - Human Resources
D. Information and communications technology (ICT), - Organization and Management
E. Coordinating mechanisms within and between the 6 Outputs:
components
- Information
2. Indicators - Service availability and quality
- A core set of indicators and related targets is the
Outcomes
basis for a health information system plan and strategy.
Indicators need to encompass determinants of health; - Service coverage
health system inputs, outputs and outcomes; and - Utilization
health status

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likely to be the least commonly available (Donaldson and
Lohr, 1994)
DEMOGRAPHIC DATA

- 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.

ADMINISTRATIVE DATA

a. services provided (e.g., diagnostic tests or outpatient

procedures), and also typically include
b. charges and amounts paid,
c. the kind of practitioner (physician, podiatrist,
psychologist),
d. physician specialty, and e. nature of institution
(general or specialty hospital, physician office or clinic,
home care agency, nursing home, and so forth).

HEALTH RISK INFORMATION

a. lifestyle and behavior (e.g., whether an individual

uses tobacco products or engages regularly in strenuous
exercise)
b. facts about family history and genetic factors to
evaluate propensity for different diseases.

PATIENT MEDICAL HISTORY

a. data on previous medical encounters such as

hospital admissions, surgical procedures, pregnancies
and live births, and the like
b. information on past medical problems and possibly
family history or events (e.g., alcoholism or parental
divorce).

CURRENT MEDICAL MANAGEMENT

a. health screening, current health problems and

diagnoses, allergies (especially those to medications)
b. diagnostic or therapeutic procedures performed,
c. laboratory tests carried out,
d. medications prescribed
e. counseling provided.

OUTCOME DATA

a. effects of health care and the aftermath of various

health problems;
b. 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
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Lesson 6 – Health Management Information System According to the Ministry of Health (2010), HMIS was
developed within the framework of the following
Problems faced by hospitals using the traditional manual concepts: THE INFORMATION IS:
process includes:
– Relevant to the policies and goals of the healthcare
• No real time data available to monitor the institution, and to the responsibilities of the health
performance of the hospital professionals at the level of collection.
• Evidence based program management was a
challenge – Functional; it is to be used immediately for
• Undue delays in receipt of data management and should not wait for feedback from
• Retrieval of old manual records was higher levels.
ineffective and time consuming.
– Integrated; there is one set of forms and no
• Duplication of records
duplication of reporting
• Monthly reports sent as hard copy which is a
real challenge for data analysis/comparison – Collected on a routine basis from every health unit.
• Drug inventory/equipment inventory (ensure completeness)
maintenance.
2002 HMIS Policy Retreat
• Lack of standard names and code
Complete: It should 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

Cost Effective: The actual usage of each element

should justify the costs of its collection and analysis

Accessible: Data should be held in a form readily

Health Management Information System (HMIS) accessible to all legitimate users, and it should be clear
- Is an information system specially designed to assist who these people are
in the management and planning of health programs, as Confidential: It should ensure that people without
opposed to delivery of care (WHO, 2014)
legitimate access are effectively denied
- It is a data collection system specifically designed to
BASIC ELEMENTS OF HMIS
support planning, management, and decision making in
health facilities and organizations.

HEALTH

- Clinical studies assist in the understanding of medical

terminology, clinical procedures, and database
processes.

MANAGEMENT

- Management principles enhanced by finance, law, and

planning help administer the health care enterprise.

INFORMATION SYSTEMS

- The ability to analyze systems and to design and

implement advanced computer applications make the
transfer of patient information efficient and effective.

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Three fundamental information-processing phases: 6. Data Update
• New and changing information is accounted
• Data Input - includes data acquisition and data
for through the element of data update. The
verification. dynamic nature of such data modification calls
• Data Management – also called processing phase for constant monitoring.
includes data storage, data classification, data
update, and data computation. C. DATA OUTPUT
• Data Output - includes data retrieval and data
7. Data Retrieval
presentation.
• Processes of data transfer and data distribution.
Eight Elements of the HMIS
• Constrained by the time it takes to transmit the
A. DATA INPUT required data from the source to the appropriate
end-user.
1. Data Acquisition
8. Data Presentation
• Generation and the collection of accurate,
timely, and relevant data. • Data presentation has to do with how users
• Input of standard coded formats (e.g., the use of interpret the information produced by the
bar codes) to facilitate the rapid mechanical system.
reading and capturing of data. • Summary tables and statistical reports may
suffice in presentations.
2. Data Verification • The use of presentation graphics for higher-level
• Authentication and validation of gathered data. managerial decision analysis is particularly
• The quality of collected data depends largely on encouraged because these appear to provide a
the authority, validity, and reliability of the data better intuitive feel of data trend.
sources. Function Data
Client Data Relates to all information of
B. DATA MANAGEMENT the client
Scheduling Observed to distribute
3. Data Storage resources to areas that need
them
• Preservation and archival of data may be Authorization Tracking Focuses on monitoring of
regarded as part of the data storage function. authorized personnel and
• When accumulated data are no longer actively their use of the authorized
used in the system, a method to archive the data units
Billing Notification of charges for
for a certain period is usually advisable and
the patient and other related
documents
4. Data Classification (aka Data Organization)
Accounts Receivable (A/R) Ensures customers are
• Critical function for increasing the efficiency of Management properly notified about their
bill
the system when the need arises to conduct a Reporting Refers to reports issued by
data search. the entity which could be
• Most data classification schemes are based on basic reports or report writer
the use of certain key parameters. Medical record EHR, a collection of digital
information about a patient
5. Data Computation Compliance Procedures that should be
followed for the
• Data manipulation and data transformation, improvement of the
such as the use of mathematical models, condition of the patient
Financial data Performance of the entity
statistical and probabilistic approaches, linear
collected for administering
and nonlinear transformation, and other data purposes (payroll and
analytic processes. account payable)
• 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.

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Determinants of HMIS 2. Technical determinants — data collection
processes, systems, forms, and methods.
I. Behavioural determinants
3. Organizational/environmental determinants —
• The data collector and users of the HMIS need Information culture, structure, resources, roles, and
to have confidence, motivation and competence responsibilities of the health system and key contributors
to perform HMIS tasks in order to improve the at each level.
Routine Health Information System (RHIS)
process.
• Lack of enough knowledge on the use of data
has been found to be a major drawback on the
data quality and information use. Motivating
HMIS users remains a challenge.
• Despite training on data collection and data
analysis, people are still having negative attitude
on the data, and hence a lot needs to be done to
change people’s behaviour, in order to increase
the performance of the (RHIS) process (Routine
Health Information Network, 2003).

II. Organizational determinants

• Health workers and data collectors work in PRISM FRAMEWORK:

organizations’ environments which have value, • Identifies the strengths and weaknesses in
norms, culture and practice. The most important
certain areas, as well as correlations among areas.
organizational factor which affects the RHIS • This assessment aids in designing and
process is related to structure, resource,
prioritizing interventions to improve RHIS
procedure, support services and the culture
performance—which in turn improves the
which is used to develop and improve the RHIS
performance of the health system.
process.
• Defines the various components of the routine health
• Having a system in place which support data
information system and their linkages to produce
collection, analysis and transform it to useful
better quality data and continuous use of
information will help in promoting evidence-
information, leading to better health system
based decision making. Thus, all components
performance and, consequently, better health
within the system are ideal in making the RHIS
outcomes.
perform better.

III. Technical determinants

• Technical factors involve the overall design used

in the collection of the information.
• It comprises the complexity of the reporting
forms, the procedure set forward in the collection
of data, the overall design of the computer
software used in the collection of information.

PRISM Framework

Performance of Routine Information System

Management (PRISM) - this conceptual framework
broadens the analysis of routine health information
systems to include the three key factors which were
discussed previously:

1. Behavioural determinants—knowledge, skills,

attitudes, values, and motivation of the people who
collect and use data.
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LESSON 7 – HMIS Monitoring and Evaluation M&E Purpose

MONITORING is the systematic collection, analysis and • The primary aim is to have a strong M&E and
use of information from programs for three basic review system in place for the national health
purposes: strategic plan that comprises all major disease
programs and health systems.
(1) LEARNING FUNCTION: Learning from the
• A robust monitoring and evaluation (M&E)
experiences acquired
system is required to assess the effect of
(2) MONITORING FUNCTION: Accounting internally and integrated service delivery . Appropriate
externally for the resources used and the results indicators, data collection systems and data
obtained analysis to support decision-making help guide
successful implementation of integrated services
(3) STEERING FUNCTION: taking decisions and measures the effect on both service delivery
and use of services.
EVALUATION is assessing an ongoing or completed
program or policy as systematically and as objectively as M&E Plan
possible. The object is to be able to make statements
about their relevance, effectiveness, efficiency, impact • The national M&E plan and system should
and sustainability. address all components of the framework and
lay the foundation for regular reviews during the
• LEARNING FUNCTION implementation of the national plan.
• MONITORING FUNCTION • Existing country health-sector review processes
are key events to assess progress and
performance. Country M&E systems should
generate the information needed for global
monitoring while minimizing the reporting burden
for countries.
• Progress of any medical institution are
monitored and evaluated through various
activities such as monitoring reports. HMIS,
surveys, and evaluation studies.

M&E Framework

• Monitoring and evaluation (M&E) is a core

component of current efforts to scale up for
better health. Global partners and countries
have developed a general framework for M&E of
health system strengthening (HSS).

The core is the strengthening of a common country

platform for M&E of HSS, which should result in better
alignment of country and global M&E systems and can
be used both for monitoring:

1. health systems funding platform

2. tracking the performance of specific programs.

The framework addresses indicator selection, related

data sources, analysis and synthesis practices (including
quality assessment), performance review,
communication and use (World Health Organization,
2009)

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Health systems strengthening (HSS) 3. It focuses on a single aspect of a program or
project the overarching objective that can be
• Includes the strategies, responses, and activities compared to – i.e., an input, output or
that are designed to sustainably improve the
performance of a country’s health system. There are different HMIS indicators which can be used
• Strong health systems can flexibly adjust for monitoring of key aspects of the health system
resources and priorities to address emerging performance.
health needs while maintaining essential
These are from among the five broad categories:
services - everything from routine checkups,
prenatal care, and immunizations, to referrals for 1. Reproductive health
more specialized or urgent medical needs. 2. Immunization
3. Disease prevention and control
The World Health Organization’s M&E of Health
4. Resources utilization and
Systems Strengthening Framework presents the
5. Data Quality
indicator domains and considerations for data
collection, synthesis and use along the pathway for Reproductive
achieving health impact at scale.
1. Family planning acceptance rate
The added value of the framework is that it brings 2. Antenatal care coverage
together indicators and data sources across the results 3. Proportion of births attended by skilled health
chain in its entirety, from “inputs/processes”, “outputs”, personnel
and “outcomes”, to “impact”. It is designed to address 4. Proportion of births attended by health extension
monitoring and evaluation needs for different users and workers at Health Post
multiple purposes, including:
Reproductive Health is a state of complete physical,
✓ monitoring of program inputs, processes and mental and social well-being and not merely the absence
results, required for the management of health of disease or infirmity, in all matters relating to the
system investments; reproductive system and to its functions and processes.
✓ health systems performance assessment, as the
key for country decision-making processes; and Immunization
✓ evaluating the results of health reform
1. DPT-3 (Pentavalent-3) coverage
investments and identifying which approaches
2. Measles immunization coverage
work best.
Disease Prevention and Control

1. New malaria cases per 1000 population

2. Malaria case fatality rate amongst under 5 years
3. New pneumonia cases amongst under 5y per 1000
population of <6yrs
4. TB case detection rate
5. TB cure rate
6. Number of clients receiving VCT services
7. PMTCT treatment completion rate
8. Number of PLWHA currently on ART

Resource Utilization

1. Tracer drug availability (in stock)

2. OPD attendance per capita
Relationship between M&E with HMIS Indicators
3. In-patient admission rate
An indicator can be defined as a 4. Average length of stay
5. Bed Occupancy Rate
1. variable whose value changes.
2. measures the value of the change in meaningful
units past and future units.

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Indicators for monitoring FP/Immunization Indicator Data Source Purpose
Number of new Family Planning Uptake of family
integration
family planning ledger / HMIS planning services
acceptors by
- Table 7.2 below provides specific indicators, data method type and
sources, and purpose of tracking each indicator in demographic/age
Reproductive Health area, as listed by the group
Contraceptive Population Survey Contraceptive use
FP/Immunization Integration Working Group. prevalence rate Data w ithin a given
population
- This table includes a variety of quantitative indicators, it Total financial cost Program data / Cost of input
is also important to complement collection of these data of inputs required to Special costing required for
integrate FP and studies integration. This
with the use of qualitative techniques in order to better immunization may be helpful in
understand nuances of the integration processes and services planning for
solicit feedback on the approach. decisions related to
sustainability and
Indicator Data Source Purpose scale-up of
INPUTS integrated services
Vaccine stockouts in HMIS, Service Monitor vaccine IMPACT
a single month statistics stock outs Maternal, infant, and Studies on maternal Measure
(YES/NO, by type of child mortality rates and infant mortality improvement in
vaccine) health status
Contraceptive HMIS, Service Monitor
stockouts in a single statistics contraceptive stock
month outs
(YES/NO, by type of
contraceptive)
Number of service Training records Monitor reach of
providers trained in EPI/FP integration
provision of EPI/FP training as an input
integrated services for effective
integrated service
delivery
OUTPUTS
Number of service Services statistics Coverage integrated
delivery points and Supervision service delivery
offering integrated
FP and
immunization
services
Number of days per Service statistics Availability of co-
month w hen both and Supervision located
immunization and (Observation + FP/immunization
family planning Interview s) services
services are offered
at the same site
Number/percent of Supplemental Quality/continuity of
w omen attending tracking column that implementation of
routine child can be added to integrated service
immunization existing delivery
services who immunization
received information register [monitored
on family planning for
from a vaccinator demonstration/pilot
programs only]
OUTCOMES
Number of children Immunization ledger Use of immunization
receiving DTP 1, / HMIS, and services, dropout
DTP 3, measles 1, population-based
and DPT 1-3 survey data
dropout
Immunization HMIS and Percentage of
coverage for DTP1, population-based children <12 months
DTP3, and measles 1 Survey Data in a given
population w ho
have received DTP1
and DTP3

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Relationship between M&E with HMIS Indicators • Cases of medical safe abortion attended at health
facilities
- HMIS is a source of routine data that is necessary
for monitoring different aspects of various health HMIS RELATED TO INTRAPARTUM CARE
programs implemented in the country. The HMIS
indicators have been carefully selected to meet the key – Deliveries by skilled attendance at health facilities
information needs of monitoring the performance of – Deliveries by health extension workers
various health programs and services and provide a – Institutional cases of maternal morbidity and mortality
snapshot of the available health resources. due to obstructed labor

The disease data provide the status report on HMIS INDICATOR RELATED TO POST PARTUM
communicable and non-communicable diseases. The CARE
following sections illustrate the relationship of HMIS – 1st post-natal care attendance
information and some of the health programs. – Institutional care of maternal morbidity and mortality
The purpose of these illustrations is to provide an in- due to Postpartum hemorrhage and Puerperal sepsis
depth understanding of how HMIS can be used for HMIS INDICATORS RELATED TO INTERPARTUM PD
monitoring program performance and how it encourages
similar in-depth analysis for all health programs and – Family planning method acceptors
services such as: – Family planning issued by type of method

1. Maternal Survival Intervention The STOP TB Program

2. Child Mortality and Child Survival Intervention
3. STOP TB Program - With the vision to have a TB free world, the goal of the
STOP TB Program (STP) is to dramatically reduce the
global burden of TB by 2015, in line with the
MATERNAL SURVIVAL INTERVENTION Millennium Development Goals and the Stop TB
Partnership targets of the World Health Organization
- The concept of knowing what works in terms of (2006).
reducing maternal mortality is complicated by a huge
diversity of country contexts and of determinants of - One of the main objectives of the program is to
maternal health. despite this complexity, only a few achieve universal access to high-quality care (i.e.
strategic choices need to be made to reduce maternal universal access to high quality diagnosis and patient
mortality. centered treatment) for all people with TB (including
those co-infected with HIV and those with drug-resistant
- This logic suggests that implementation of an effective TB).
intrapartum-care strategy is an overwhelming priority.
- TB case detection and successful completion of the
HMIS RELATED TO PREGNANCY CARE treatment/cure of the TB remains at the core of the Stop
INTERVENTION TB Strategy.
• Antenatal care coverage – First visit - Hence one of the targets linked to the MDGs and
– The percentage of women that received antenatal care endorsed by the Stop TB Partnership is by 2050 to
at least once during the current pregnancy reduce prevalence and deaths due to TB by 50%
compared with a baseline of 1990.
• Antenatal care coverage – four visits
- The following flowchart puts the HMIS indicators (in
– The percentage of women that received antenatal care green shaded boxes) in the context of the STOP TB
four or more times during the current pregnancy. Program.

• Cases of abnormal pregnancies attended at OPD of

health facilities
• Institutional cases of maternal morbidity and
mortality due to Antepartum Hemorrhage,
hypertension and so on
• Cases of abortion attended at health facilities •
•

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HMIS Indicators to Monitor STOP TB Program TB

patients on DOTS

1. Number of new smear pulmonary TB cases enrolled

in the cohort
2. TB Case Detection
3. Number of New smear positive pulmonary TB cases
detected
4. Number of new smear negative pulmonary TB cases
detected
5. Number of new extra pulmonary TB cases detected
6. HIV – TB – Co-infection
7. Proportion of newly diagnosed TB cases tested to HIV
8. HIV+ new TB patients enrolled in DOTS
9. TB Treatment outcome
10. Treatment completed PTB+
11. Cured PTB+, Defaulted PTB+, Deaths PTB

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Lesson 8 – HMIS Data Quality • It is intended for use with or without rigorous
sampling methods. It is designed to be flexible and
Data Quality
can be used by program managers, supervisors, and
is the overall utility of a dataset(s) as a function of its monitoring and evaluation staff at national and
ability to be processed easily and analyzed for a subnational levels, and by donors and stakeholders
database, data warehouse, or data analytics system.
DQA RDQA
Aspects of Data Quality Standardized approach to Program self-assessment
implementation
➢ Accuracy Conducted by external Flexible use by programs
➢ Completeness auditing team for monitoring and
➢ Update Status oversight or to prepare for
➢ Relevance an external audit
➢ Consistency Limited entry The program develops
recommended by and implements its own
➢ Reliability
programs action plan.
➢ Appropriate presentation
➢ Accessibility
Routine Data Quality Assessment (RDQA)
Lot Quality Assurance Sampling
The Routine Data Quality Assessment Tool (RDQA) is a
• According to the World Health Organization, LQAS
simplified version of the Data Quality Audit (DQA) which
was initially used to determine whether a batch, or
allows programs and projects to verify and assess
lot, of a product met the desired specifications.
the quality of their reported data.
Manufacturers took a sample of the product and
defined how much risk they were willing to take for The objectives of RDQA are as follows:
not inspecting each item. Then they accepted or
rejected the entire lot based on these risks. Many
manufacturers began to prefer the LQAS approach
because it did not require that every single item be
checked for defects.
• The only outcomes in this type of sampling are
“acceptable” or “not acceptable,” and there are no Development Implementation Plan (aka Action Plan)
varying levels of unacceptability.
- An Implementation Plan is a project management tool
DQA that shows how a project will evolve at a high level. An
• The objectives of the DQA Tool for auditing are to: implementation plan helps ensure that a development
o Verify the quality of reported data for key team is working to deliver and complete ta sks on
indicators at selected sites; and time (Visual Paradigm, 2009).
o Assess the ability of data management - The development of an Implementation Plan is
systems to collect and report quality data. important to ensure that the communication between
o In addition, for the programs/projects being those who are involved in the project will not
audited, the findings of the DQA can also be encounter any issues and work will also be delivered
very useful for strengthening their data on time. The plan validates the estimation and schedule
management and reporting systems. of the project plan.
Routine Data Quality Assessment (RDQA) An Implementation Plan has the following key
components:
• The Routine Data Quality Assessment (RDQA) is a
simplified, self-assessment version of the DQA Tool. 1. Define Goals/Objectives: Answers the question
It allows programs and projects to assess the quality “What do you want to accomplish?”
of their own data and strengthen their data 2. Schedule Milestones: Outline the high level
management and reporting systems. schedule in the implementation phase.
• The RDQA is generic with regard to indicators and 3. Allocate Resources: Determine whether you have
programs. sufficient resources, and decide how you will procure
what’s missing.
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4. Designate Team Member Responsibilities: Create What is a Root Cause Analysis?
a general team plan with overall roles that each team
member will play. A root cause analysis is a class of problem-solving
5. Define Metrics for Success: How will you determine methods aimed at identifying the root causes of the
if you have achieved your goal? (Smartsheet, 2017). problems or events instead of simply addressing the
obvious symptoms. The aim is to improve the quality of
Data Quality Tools the products by using systematic ways in order to be
effective (Bowen, 2011).
- A data quality tool analyzes information and
identifies incomplete or incorrect data. Cleansing Techniques in Root Cause Analysis
such data follows after the completion of the profiling of
data concerns, which could range anywhere from Root cause analysis is among the core building blocks in
removing abnormalities to merging repeated the continuous improvement efforts of the organization.
information. 1. ASK WHY 5 TIMES
- By maintaining data integrity, the process enhances - This might sound like the technique of a five-year old
the reliability of the information being used by a wanting to get out of going to bed, but the five whys
business. Usually these data quality software products analysis can be quite useful for getting to the underlying
can share features with master data management, data causes of a problem.
integration, or big data solutions.
- By identifying the problem, and then asking "why" five
- As data quality becomes increasingly all- times - getting progressively deeper into the
encompassing, currently, data integration tools usually problem, the root cause can be strategically
include data quality management functionality. identified and tackled.
Parsing and standardization 2. Failure Mode and Effects Analysis (FMEA)
– refers to the decomposition into component parts and The failure mode and effects analysis (FMEA) is a
formatting the values into consistent layouts based on technique which is aimed to find various modes for
industry standards and patterns and user-defined failure within a system. FMEA requires several steps
business rules for execution:
Generalized “cleansing” ✓ All failure modes (the way in which an observed
– means the modification of data values to meet domain failure occurs) must be determined.
restrictions, constraints on integrity or other rules that ✓ How many times does a cause of failure occur?
define data quality as sufficient for the organization ✓ What actions are implemented to prevent this
cause from occurring again?
Matching ✓ Are the actions effective and efficient?

– this is the identification and merging related entries FMEA is often performed and updated a ny time a
within or across data sets new product or process is generated, when changes
are made to current conditions, or to the design, when
Profiling new regulations occur, or when there is a problem
– refers to the analysis of data to capture statistics or determined through customer feedback.
metadata to determine the quality of the data and 3. Fault Tree Analysis (FTA)
identify data quality issues
- Uses boolean logic to determine the root causes of an
Monitoring undesirable event. This technique is usually used in
– the deployment of controls to ensure conformity of risk analysis and safety analysis.
data to business rules set by the organization - At the top of the fault tree, the undesirable result is
Enrichment listed. From this event, all potential causes tree down
from it. Each potential cause is listed on the diagram in
– enhancing the value of the data by using related the shape of an upside-down tree.
attributes from external sources such as consumer
demographic attributes or geographic descriptors

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4. Current Reality Tree (CRT) Investigate - a diagnostic plan is created and the root
cause is identified through careful analysis of the
- The current reality tree analyzes a system at once. It diagnostic data
would be used when many problems exist and you want
to get to the root causes of all the problems. Fix - the problem is fixed and monitored to ensure that
the proper root cause was identified.
- The first step in creating a current reality tree is listing
all of the undesirables or, problems. Then begin a chart
starting with each of those problems using causal
language (if...and...then). The tree will depict each
potential cause for a problem.

- Eventually, the tree will show one cause that is linked

to all four problems.

4. Fishbone or Ishikawa or Cause-and-Effect

Diagrams

- No matter what term you use for the fishbone diagram,

the truth is, that it is a useful technique that will help you
in your root cause analysis. A fishbone diagram will
group causes into categories including:

✓ People
✓ Measurements
✓ Methods
✓ Materials
✓ Environment
✓ Machines
5. Kepner-Tregoe Technique

The Kepner-Tregoe technique, also known as rational

process is intended to break a problem down to its
root cause. This process begins with a:

1. Appraisal of the situation - what are the priorities

and orders for concerns for specific issues?

2. The problem analysis is undertaken to get to the

cause of undesired events.

3. A decision analysis is tackled, outlining various

decisions that must be made.

4. A potential problem analysis is made to ensure that

the actions decided upon in step three are sustainable.

7. RPR Problem Diagnosis

- One final technique used in root cause analyses is the

RPR Problem diagnosis. RPR stands for "Rapid
Problem Resolution" and it deals with diagnosing the
causes of recurrent problems.

This process has three phases:

Discover - team members gather data and analyze their

findings

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Lesson 9 – Hospital Information System advances in technology and more hospitals now turn to
RIS to control the commercial enterprise side of their
A hospital information system (HIS) is fundamentally a practices.
computer system that could manage all the information
to permit health care providers to do their jobs efficiently. 4. Pharmacy Information Systems (PIS) – Designed to
cope with the demands of a pharmacy department, PIS
The staff used them generally for dealing with billing enables pharmacists monitor how medicine is utilized in
and hospital inventory. All this has changed now, and hospitals. A PIS facilitates users supervise drug allergies
today hospital information systems include the and different medication-related complications. The
integration of all scientific, financial and system enables users to identify drug interactions and
administrative programs. also helps administer the appropriate drugs based on
An effective HIS additionally provides benefits including: the patient’s physiologic conditions.

• enhanced facts integrity Selecting a Hospital Information System

• reduced transcription errors 1. Total cost of package
• reduced duplication of facts entries
• optimized report turnaround times – discuss the necessities of your hospital with you.
Solutions are available for hospitals of all sizes and
HIS for Different Departments budgets.
1. Nursing Information Systems (NIS) – these 2. Web based system
computer based information systems are designed
to assist nurses offer enhanced patient care. A good – in addition to the user friendly features, an excellent
NIS can carry out a number of functions and supply HIS system ought to be available on the internet.
benefits together with improving personnel Availability on the internet means authorized employees
schedules, accurate patient charting and better can access the information whenever they need from
clinical data integration. anywhere. this does not bind all caregivers to their office
• Patient charting applications also permit users to desks and additionally offers them with statistics
go into details regarding patients’ critical signs. 3. Implementation and support
Nurses also use it for admission information,
care plan and all applicable nursing notes. All – Change is continually resisted by people and
crucial facts are securely saved and can be deploying or upgrading a hospital information system
retrieved when required. can also invite employee criticism. It is always good to
• Medical information integration is also very invite the vendor for assistance in an implementation
useful, allowing nurses to collect, retrieve and and request for staff training. Select a vendor that gives
examine the medical records after which 24/7 support thru the telephone or web, so your hospital
integrate it to design a patients’ care plan. staff can at once access support.
2. Physician Information Systems (PIS)
• As the name suggests, PIS systems aim to HIS PROVIDERS IN THE PHILIPPINES
enhance the practice of physicians and also are 1. BIZBOX
encouraged by the government for deployment. • The founders of Bizbox, Inc., started twenty-five
• PIS are added thru computers, servers, (25) years ago with the goal of helping
networks, and use extensively deployed and people improve their work efficiency through
popular programs such as, Electronic Medical software. With the first hospital project in 1994,
Records (EMRs), Electronic Health Records BizBox evolved into one of the top IT companies
(EHRs), and others. focused on the healthcare industry.
• Most of these offerings have 24/7 support that • All the healthcare solutions developed by BizBox
enables health professionals to troubleshoot uses the latest technology from Microsoft.
issues happening at some point in their use. Leveraging on Windows Server, SQL Server
and Net. BizBox builds mission-critical
3. Radiology Information System (RIS) – these
applications for the healthcare environment.
systems are also popular for their capability to provide
Bizbox is proud to be a Microsoft Gold
radiology billing services, appointment scheduling as
Certified Partner and the recipient of the ISV
well as reporting and patient database storage. The
of the Year Award.
radiology practice has become more complicated with
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2. KCCI MEDSYS hospitalization. Other routine tests can be carried out at
• Kaiser – dela Cruz Consulting, Inc. (est.1990) the day of your admission.
specializes in application development for
hospitals, industrial clinics and medical related 5. Discharge
educational institutions in the Philippines. Their - Discharge from the hospital is the point at which the
products Visual MEDSYS for Hospitals and patient leaves the health facility and either returns
MEDSCHO for Schools provide integrated, home or is transferred to some other facility including
comprehensive, and proven solutions. one for rehabilitation or to a nursing home. Discharge
3. COMLOGIK entails the medical instructions that the patient will need
• Comlogik Business Systems, Inc. is a to fully recover. Discharge planning is a service that
Philippine based software development considers the patient's needs after the hospital stay, and
company that established its operation in the may involve numerous exceptional services which
year 1999 with a vision to be a Global includes visiting nursing care, physical therapy, and
Technology Company. Comlogik led the way in home blood drawing.
developing innovative applications like online
hospital services wherein patients can 6. Transfer
access their billing as well as the examination
- The term "transfer" means the movement (along with
results, while your Administrators can access
the discharge) of an individual outside a hospital's
their reports and your Doctors their patient’s
premises at the instruction of any person employed by
records anywhere and anytime they need to
(or affiliated or related, directly or indirectly, with) the
PROCESSES WHICH CAN BE DONE USING HIS hospital. This, however, does not encompass movement
of an individual who (A) has been declared lifeless, or
1. Help Desk (B) leaves the facility without the permission of any
such authorized person.
- A help desk is a useful resource meant to offer the
customer or end user with information and guide 7. Billing
associated with a company's or institution's products and
service - Itemize all of a purchaser's invoices and payments,
and maintain a rolling balance of how much they owe.
2. Scheduling
- Statements are valuable for customers that order from
- Managers and employees can access work schedules you on a frequent basis.
from everywhere and effectively discuss their scheduling
preferences. An employee scheduling software could - Through generating statements on a regular basis (at
save you time and make employee scheduling less least monthly), you'll be able to keep track of who owes
difficult. you and how much.

3. Patient Registration - The HIS will display a list of those customers that have
outstanding balances, and you can page through each
- A patient registration form needs to be filled up statement and quickly isolate someone if their payment
whenever a patient visits a hospital or clinic to avail of is overdue.
medical treatment.
PHYSICIAN PRACTICE
- The data is used for record keeping and
administrative use. If the patient calls for any prompt • Increasingly, physicians are being employed
medical attention for the duration of an emergency, the within one of several practice models. Some
form can be filled up by any relative, friend, or guardian. hospitals may purchase and manage existing
solo or group practices, or may directly hire
4. Admission physicians to work in their inpatient facility or
ambulatory clinics. Health care corporations may
- Before you are admitted to the health facility, an
own and run clinics with employed physicians.
admissions counselor will call you to gather preliminary
And some physician-run groups are structured
information, offer vital information concerning your
hospital stay and answer your questions. Your physician on an employment model, where a group
practice is structured more like a corporation that
additionally may schedule recurring medical exams,
such as laboratory tests or X-rays, before your employs clinicians instead of pursuing a more
traditional partnership model.
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• The downside of being an employed physician is LABORATORY, RADIOLOGY AND CARDIOLOGY
that physician autonomy may be substantially REPORTING
diminished relative to other practice models.
Scheduling and productivity expectations may A. Laboratory Reporting
be beyond your control, and policies and - Despite the differences in presentation and from, all
procedures may be developed by others without laboratory reports must possess common elements as
your input. There may be less clinical flexibility required by federal legislation or by company policies.
due to limitations of referrals and facilities based
on the employing organization. Additionally, - It may also contain supplementary items not
there may be other expectations as an employed specifically required, but which the lab chooses to report
physician, such as serving on committees or to aid in the interpretation of results (American
participating in other organizational activities. Association for Clinical Chemistry, 2017).

SPECIAL FEATURES OF HIS For identification and filing purposes, some lab reports
display elements with administrative or clerical
A. Contract Management information:
Goodrich (2013) defines contract management as the ✓ Patient name and identification number or a
“process of managing contract creation, execution and unique patient identifier and identification
analysis to maximize operational and financial number
performance at an organization, all while reducing ✓ Name and address of the laboratory location
financial risk. where the test was performed
✓ Date report printed
B. Package Deal Designer
✓ Test report date
Posting Diagnostic Medical Packages for Inpatients, ✓ Name of doctor or legally authorized person
Outpatients and Emergencies requires the same ordering the test(s)
process; the difference is that for Emergencies this is ✓ Information about the specimen and the test
called Post-Diagnostic Package Deal. itself, such as those included below, are other
elements that make a lab report more
C. Accounts Receivables meaningful:
Investopedia (2017) defines accounts receivable as “the ✓ Specimen source, when appropriate
outstanding invoices a company has or the money the ✓ Date and time of specimen collection
company is owed from its clients.” The phrase refers to ✓ Laboratory accession number
accounts a business has a right to receive because it ✓ Name of the test performed
has delivered a product or service. ✓ Test results
✓ Abnormal test results
CONSUMPTION ENTRY = storage of goods ✓ Critical results
✓ Units of measurement (for quantitative results)
• A consumption entry is duty entry for the goods ✓ Reference intervals (or reference ranges)
which have been imported from an international ✓ Interpretation of results
carrier and sent for use in the commercial ✓ Condition of specimen
market directly. ✓ Deviations from test preparation procedures
✓ Medications, health supplements, etc. taken by
Apart from Consumption entry, following entries are also
the patient
used:
B. Radiology Reporting
➢ Transportation entry: When goods are in
transit to a third country - A radiology report is a clinical and source document
➢ Warehouse entry: When goods are stored in a that provides interpretation and describes any radiology
bonded warehouse before going to the market procedure conducted by a radiologist. The only person
➢ Foreign Trade Zone Entry: When goods are who is privileged to prepare and document a radiology
stored in a place licensed by the department of report is a qualified physician who has been granted
commerce of that country specific clinical privileges in that hospital or clinical
➢ Temporary in Bond Entry settings.
➢ Drawback Entry

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1. The length of the report should have some falls on the nurse and detracts from his or her
relationship to the complexity and cost of the exam. primary task feature: offering patient care.
2. It should have pertinent positive and negative findings • As such, the automation of an inventory or material
and address any specific clinical concerns. management system is a definite need for a hectic
3. All important findings need to be stated first and any health center to streamline the hospital supply chain.
incidental findings are reported at the end. These computerized stock management systems
include technologies for tracking and tracing
The radiology report's main premise is to answer the
inventories and devices used each day in a
clinical question from the radiology request. The main
healthcare setting. Generally, they utilize barcodes
components are:
and RFID tags with precise identification numbers
1. Patient's demographics. Name, social security for each inventory object to enable accurate tracking
number, etc. and control.
2. Relevant clinical information and ICD-9 code.
MANAGEMENT REPORTING
3. Body of the report.
4. Impression (conclusion or diagnosis) • A management reporting system provides business
information. Historically, MR structures were simply
C. Cardiology Reporting
used retrieve up data. However, the system has
• Vascular sonography reports can be created with a undergone tremendous transformation over time,
touch of a few buttons if software designed for making it a strong platform for reporting and control.
cardiology is used. Vascular software programs Because of the advancement in technology, it is able
understand the needs of the medical staff that to now offer financial and nonmonetary information,
prepare and read these reports and are quite which could help management take essential actions
intuitive. in the oversight of their business activity.
• Vascular sonography reports will indicate valuable
Kumar (2017) also enumerates six reasons giving rise to
information about the results of the ultrasonic the need for a Management Reporting System:
ultrasound and might include diagrams of the veins
and arteries to help determine and measure items • Constant need of reports for decision making and
such as blood flow, presence of plaque, narrowing analysis of trends
and the presence of clots. • Reports being unavailable with the right
stakeholders at the right time
DISCHARGE SUMMARY
• Lack of visibility and a single holistic view of the
• A discharge summary is a clinical report arranged by enterprise performance
a health practitioner or different health expert at the • Data redundancy, duplication of data leading to
conclusion of a hospital stay or series of treatments. data management and quality issues leading to
• It outlines the patient's main complaint, the error prone reports
diagnostic findings, the treatment administered and • High value resources
the patient's response to it, and guidelines on • Changing a global report to fit local needs
discharge.

MATERIAL MANAGEMENT SYSTEM – PHARMACY,

MAIN STORES AND PURCHASE

• Material management is basically concerned with

the planning, identifying, purchasing, storing,
receiving and distribution of materials. The purpose
of material management is to guarantee that the
right materials are in the right location, in the right
quantities when needed.
• A better inspection of a nursing unit, OR suite, or
exam floor reveals a smaller, self-managed
inventory in supply closets, nurses’ stations and
individual rooms. Despite the fact that that is
essential to maintain supplies conveniently available
on the point of use, the weight of keeping the supply
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