ROUTINE HEALTH INFORMATION SYSTEMS
A Curriculum on Basic Concepts and Practice
MODULE 8:
Information and Communication Technology for RHIS
SESSION 1:
eHealth, mHealth, and Health Information System
Enterprise Architecture
The complete RHIS curriculum is available here:
https://www.measureevaluation.org/our-work/ routine-health-information-systems/rhis-curriculum
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Session 1: eHealth, mHealth, and HIS Enterprise
Architecture
Learning Objectives
By the end of this session, participants will be able to:
Explain key eHealth and mHealth concepts
• Define commonly used eHealth and mHealth terms
• Illustrate eHealth and mHealth applications
• Describe limitations and considerations for eHealth and
mHealth
Explain key HIS enterprise architecture (EA) concepts
• Explain the need for the EA approach
• Describe HIS architecture and its ecology
Topics Covered
• eHealth and mHealth
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eHealth
• eHealth (or e-health) is a relatively recent term for healthcare
practice supported by electronic processes and communication, dating
back to at least 1999.
• World Health Organization definition: eHealth is the cost-effective
and secure use of information and communications technologies in
support of health and health-related fields, including healthcare
services, health surveillance, health literature, and health education,
knowledge and research.
• European Commission: the use of modern information and
communication technologies to meet needs of citizens, patients,
healthcare professionals, healthcare providers, and policymakers
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Common Terms in eHealth
• Electronic health record (EHR), or electronic medical record (EMR):
systematized collection of patient and population health data in a digital
format that is electronically-stored
• Clinical decision support system (CDSS): ICT solution designed to
provide health professionals with clinical decision support (CDS) such as
assistance with clinical decision-making tasks
• Telemedicine: physical and psychological diagnosis and treatments at a
distance, including telemonitoring of patient functions
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eHealth Interventions
• Delivering health information to health professionals and health
consumers through the Internet and telecommunication
• Using IT and e-commerce to improve public health services―for
example, through the education and training of health workers
• Applying e-commerce and e-business practices in health systems
management (planning, budgeting, accounting, etc.)
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Why eHealth?
• In many low- and middle-income countries (LMICs), health system
challenges relating to weak governance, health workforce shortages, and
geographic and economic barriers to care impede effective delivery of
health services to those in need.
• Information and communication technology (ICT) offers the potential for
addressing some of these challenges with innovative solutions, especially if
offered at scale.
• LMICs account for three-quarters of the rapidly expanding Internet and
mobile cellular subscriptions globally, thus creating opportunities for
innovative and cost-effective health services through the use of ICT.
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Application of eHealth in HIS
Data collection
• Use of hand-held devices
• Automated information messaging
• Use of different data management applications such as DHIS 2, iHRIS,
and eLMIS to collect, aggregate, and report routine data.
Data management and storage
• To address requirements of interoperability and integrated sets of data
• More sophisticated data storage to address complexity and variability of
health data across the health enterprise
• Relational databases are increasingly the norm, as opposed to the older,
flat database formats that limited functionality and scalability, such as
Microsoft Excel workbooks
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Application of eHealth in HMIS
Data analysis, presentation, and use
• Extraction and triangulation of health data
• Data analysis and synthesis tools to produce routine or ad hoc
reports, identify trends and issues of concerns, and track progress
• Data dashboards and other data visualization tools can be
customized to include maps (geographic information systems, or
GIS)
Data quality
• Tools for improving data quality include data standardization,
geocoding, data matching, data monitoring, and profiling.
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Common Terms in mHealth
mHealth or m-Health: includes the use of mobile devices in:
• Collecting aggregate and patient-level health data
• Providing healthcare information to practitioners, researchers, and patients
via Short Message Services (SMS) platforms such as mHero
• Real-time monitoring of patient vital signs and direct provision of care
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mHealth Applications
• Rapid collection/sharing of current data via mobile phones
• Public health and lifestyle messages over mobile phones
• Medication alerts using mobile phones
• E-prescribing for repeat prescriptions via mobile phones
• Telemonitoring to transmit patient results to clinicians
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mHealth Applications
• Transmission of test results to patients via SMS messages
• Online electronic health records via computer or phone
• Clinical emergency care for accidents, natural disasters
• Patient appointment booking and alerts via wireless e-mail
(continuity of care)
• Efficient workflow via wireless communication
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Limitations and Considerations
• Lack of knowledge by health professionals concerning the
possible applications of eHealth
• Unknown cost-effectiveness of mHealth/eHealth initiatives
• Cost of implementing eHealth solutions is perceived to be high
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Limitations and Considerations
• ICT infrastructure and particularly Internet access limited by
low connectivity and bandwidth (urban areas are better covered
than rural areas)
• Absence of legal guidelines on privacy and confidentiality in
the eHealth and mHealth domains
• Change management to consider to deal with the new ICT
cultural environment
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HIS Architecture
HIS ARCHITECTURE
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Ecology of HIS in LMICs
• Widespread dissatisfaction among both users and producers of
health information
• Complex and fragmented by disease-focused programs and
donors
• Epidemic of indicators and burdensome demands on health
personnel
• Poor quality data; lack of common standards; data
inconsistencies and inefficiencies; difficult to analyze and
synthesize
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What Is Enterprise Architecture?
Enterprise architecture is the technical foundation of an effective IT
strategy. It consists of four types of interrelated architecture:
1. Business architecture
2. Data or information architecture
3. Application architecture Health information
4. Technology architecture system (HIS) architecture
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Need for Enterprise Architecture?
To give management the big picture
Enterprise architecture gives a “systems thinking” view that combines vision and
strategy, business architecture, information systems, and technology domains.
To align IT investments with business goals
Creating a platform for business-ICT stakeholder collaboration is essential.
Effective EA supports strategy, analysis, and planning by providing stakeholders a
blueprint of the current state of the business and IT landscape, and of the desired
future state (vision).
To provide IT developers with specific requirements for software applications
The business architecture provides the IT developer with the specific software
requirements of an application.
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Enterprise Architecture
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HIS Architecture Principles
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HIS Architecture
• Can align and leverage investments to build stronger and better
integrated HIS supporting better health policy and local health
services management, and ultimately stronger health systems
• To be built on a coherent set of best practices for promoting data
integration
• To foster stakeholder groups to collaboratively build on common
components and a common architecture within the HIS
• Helps identify and create interoperability between the components
of the system
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Rwanda Health Enterprise Architecture Framework
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Summary
• Plethora of tools, methods, and practices for data collection and analysis
have created an unsustainable burden on frontline health workers.
• This burden causes poor data quality and diverts critical health resources
from using information for decision making at all management levels.
• An enterprise architecture approach can help address these challenges.
• Improving health system performance through the consistent use of EA
will be the blueprint for better health outcomes resulting from the
routine use of better information to stronger national health information
systems.
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ROUTINE HEALTH INFORMATION SYSTEMS
A Curriculum on Basic Concepts and Practice
This presentation was produced with the support of the United States Agency for International
Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-
L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of
North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management
Sciences for Health; Palladium; and Tulane University. The views expressed in this presentation do not
necessarily reflect the views of USAID or the United States government.
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