Lesson 1: Vision, Mission, Core Values, and Objectives of the

Institution

Educational Institution
An educational institution is a place where learners of different ages gain education.
Education is based on an age grade system from preschool, primary, intermediate, and secondary
level (junior and senior high school), to tertiary level (colleges and universities). Educational
institutions carry out educational activities that engage students with various learning
environments and spaces.
However, not all types of educational institutions are structured and formalized. While
established educational institutions follow a well-defined curriculum, some learning environments
are spontaneous and have no fixed timetables.
There are two types of education: formal and informal.
Formal education deals with the conventional classroom setup where structured methods
of learning are administered in educational institutions. Government recognition in terms of the
curricular offering that predetermines the books and materials to be used for instruction is
necessary to establish standards in the academic community. Faculty and instructors follow the
curricula set by a technical committee appointed by the government. Formal education starts at
around age 4 from preschool up to higher education. It takes place in a stipulated period in which
learners complete each level by acquiring the required competencies in preparation for higher
learning.
Informal education, on the other hand, is anything learned independently outside the
conventional classroom setup. It is not restricted to a certain location and is usually integrated with
the surroundings such as the home, cultural setting, and even in formal education institutions.
Informal education involves the students' behavior skills through interaction and exploration on a
daily basis as well as the teachers' traits that vary based on their expertise, skills, and experience.

Vision and Mission Statement

Vision Statement
A vision statement conveys the desired end of an academic institution. It is usually a one-
sentence statement that describes the distinct and motivating long-term desired transformation
resulting from institutional programs. The vision statement should be clear, memorable, and
concise with an average length of 14 words. The shortest contains only three words—such as
"Equality for Everyone," a human rights campaign—while the longest may contain up to 26
words—such as "A World in which every person enjoys all of the human' rights enshrined in the
Universal Declaration of Human Rights and other international human rights instruments" of
Amnesty International.
Mission Statement
A mission statement is a one-sentence statement relating the intention of an institution's
existence. This communicates what you do or who you do this for. The mission statement must be
clear by using simple language with an average of 5 to 20 words. Examples include "Spreading
Ideas" by TED, "The increase and diffusion of knowledge" by the Smithsonian, and "Seeking to
put God's love into action, Habitat for Humanity brings people together to build homes, community
and hope" by Habitat for Humanity.
Below is the detailed comparison between a vision statement and a mission statement.
Table 1.1 Comparison between a vision statement and a mission statement
Vision Statement Mission Statement
Function It inspires to give the best and It defines the key measure of
shapes your understanding of the Institution’s success.
why you are in the institution.
Developing Statement When do we want to reach What do we do today?
success? For whom do we do it?
Where do we want to go Why do we do what we do?
forward?
How do we want to do it?

Time Talks about the future Talks about the present

leading to the future

Question Where do you aim to be? What makes you different?

Where do you want to be? How will you get where you
want to be?

Value Statement
A value statement, or the core values, is a list of fundamental doctrines that guide and
direct the educational institution. This sets the moral direction of the institution and its academic
community that guides decision-making and provides a yardstick against any action. The core
values shape the standard structure that is shared and acted upon by the academic community.
In developing an institution's value statement, consider the following questions:

 What values are distinct to our educational institution?

 What values should direct our institution?
 For an educational institution to have a useful value statement, its values must be incorporated
in all levels of the institution to give direction to its engagements, viewpoints, and decision-making
processes.

Objectives
Educational objectives, or goals, are short statements that learners should achieve within
or at the end of the course or lesson. When setting the objectives, curriculum developers must think
of the SMART criteria; that is, objectives must be Specific, Measurable, Attainable, Realistic, and
Time bound.
Below is a list of educational objectives set by the Commission on Higher Education
(CHED) through CHED Memorandum Order No. 14, series of 2006 on "Policies, Standards, and
Guidelines for Medical Technology Education."
The Medical Technology Aims to:
1. Develop the knowledge, attitudes, and skills in the performance of clinical laboratory
procedures needed to help the physician in the proper diagnosis, treatment, prognosis and
prevention of disease.
2. Develop skills in critical and analytical thinking to advance knowledge in Medical
Technology/ Clinical Laboratory Science and contribute to the challenges of the
profession.
3. Develop leadership skills and to promote competence and excellence; and
4. Uphold moral and ethical values in the service of society and in the practice of the
profession

Key Points to Remember

 An educational institution carries out educational activities that engage students with
various learning environments and spaces.
 Education is based on an age grade system from preschool, primary, intermediate, and
secondary level to the tertiary level.
 A vision statement is the desired end of an academic institution. It is usually a one-sentence
statement that describes the distinct and motivating long-term desired transformation
resulting from institutional programs.
 A mission statement is a one-sentence statement relating the intention of an institution's
existence.
 A value statement, or core values, is a list of fundamental doctrines that guide and direct
the educational institution.
 An educational objective is a short statement that a learner should achieve within or at the
end of the course or lesson.
 Lesson 2: Health System
Health System
Health systems "the combination of resources, organization, financing, and management
that culminate in the delivery of health services to the population (Roemer, 1991)." This system
consists of many parts such as the community, department or ministries of health, health care
providers, health service organizations, pharmaceutical companies, health financing bodies, and
other organizations related to the health sector. Each plays a role in the system such as governance,
health service provision, and financing and managing resources.
 In the World Health Report (WHO, 2000), health system is defined as "all the organizations
institutions, resources, and people whose primary purpose is to improve health." Thus, a well-
performing health system provides direct health-improving activities whether in personal health
care, public health services, or intersectoral initiatives, to achieve high health equity.

Goals and Functions of a Health System

The World Health Organization (WHO) identifies three (3) main goals of a health system:
1. Improving the health of populations
Improving the health of the population is the overarching goal of a health system. Health
status should thus be measured over the entire population and across different socioeconomic
groups. Populations must be protected from existing and emerging health risks. Intensive
preparations for resilience to impending but still unknown health risks must be executed to ensure
the safety of populations. Health systems should strive for equity in health by minimizing
inequitable disparities which may be caused by certain factors such as income, ethnicity,
occupation, gender, geographic location, and sexual orientation, among others. There are
significant variations in health outcomes across the world, within regions and within countries.
Countries and regions with relatively similar socioeconomic status may have quite disparate health
outcomes. The way health systems are organized contributes to this disparity. These disparities are
most effectively reduced when they are recognized and their minimization becomes an explicit
national goal.
2. Improving the responsiveness of the health system
Responsiveness refers to providing satisfactory health services and engaging people as
active partners. It embodies the values of respectfulness, dignity, confidentiality, autonomy,
quality, and timeliness in the delivery of health services. Health systems also have an obligation
to respond to the legitimate non-health needs and expectations of populations. Responsive health
systems maximize people's autonomy and control, allowing them to make choices and placing
them at the center of the health system.
3. Providing fair health financing
An ideal health system provides social and financial risk protection in health. Thus, all
health systems must be adequately funded to provide essential services to all citizens. WHO
defines a fairly financed health system as one that does not deter individuals from receiving needed
care due to payments required at the time of service, and one in which each individual
paysapproximately the same percentage of their income for needed services. A health financing
system that dissuades people from seeking needed services or impoverishes individuals and
families worsens health outcomes.
The four (4) vital health system functions are:
1. Health service provision
The most visible product of the health system is public and private health service provision.
A health service is any service, not limited to clinical services, aimed at improving the health of
populations. Preventive measures as well as promotion of a healthy way of living to avoid illnesses
also form part of the best systems. Thus, the system has to perform a wide range of activities to
cater to these various demands.
2. Health service outputs
Health service inputs, or managing resources, means generating the essential physical
resources for the delivery of health services which include medications, human resources, and
medical equipment. Resources such as trained doctors and medical staff and supply of medications
often take time to be produced; hence, the health system policymakers have to respond and use the
available resources to address short-term population needs.
3. Stewardship
Stewardship, or the overall system oversight, is the main responsibility of the government.
This function sets the direction, context, and policy framework for the overall health system.
The core of the stewardship function includes:
a. Identifying health priorities for allocation of public resources;
b. Identifying an institutional framework;
c. Coordinating activities with other systems related to external health care;
d. Analyzing health priorities and resource generation trends and their implications; and
e. Generating appropriate data for effective decision-making and policymaking on health
4. Health Financing
Health system financing includes raising and pooling resources to pay for health services.
a. Revenue Collection
Revenue is earned from payments for health care services. The mechanisms for revenue
collection include general taxation, direct household out-of-pocket expenditures, mandatory
payroll contributions, mandatory or voluntary risk-rated contributions, donor financing, and other
forms of personal savings.
Each source of health financing is associated with a specific manner of organizing and
pooling of funds and purchasing services. Public health systems rely on general taxation for its
financing, while social security organizations are funded through the mandatory payroll
contributions from workers and employers.
 b. Risk pooling
Financial risk pooling is a form of risk management which aims to spread fin risks from an
individual to all pool members. It is considered a core function of health insurance companies.
This mechanism prevents outright payment for health services which discourages patients
belonging to the poor sector from seeking health Participation in effective risk pooling helps
families from financial losses due to health shocks, thus ensuring financial protection.
Each country has its own approach to managing its financial risk to finance its health care
system. Multiple and fragmented forms of risk pooling arrangements exist in most developing
countries. Most high-income countries follow one of the two main models: the Bismarck model
and the Beveridge model.
 Bismarck Model (Bismarck's Law on Health Insurance of 1883)
This model is named after the Prussian Chancellor, Otto von Bismarck, known for
inventing the welfare state in the 19th century as part of the unification of Germany. The Bismarck
model uses an insurance system where the sickness fund finances both the employers and the
employees through payroll deduction. But unlike the US insurance industry, the Bismarck-type
health insurance plan covers everybody, thus collecting no profit. This is considered a multi-payer
model with tight regulation giving the government the cost-control clout. This model is widely
used in Germany, France, Belgium, Netherlands, Japan, Switzerland, and, to a degree, in Latin
America.
 Beveridge Model (Beveridge Report or the Social Insurance and Allied Services of 1942)
This model is named after William Beveridge, the social reformer responsible for designing
Britain's Social Security System and the National Health Service. In the Beveridge model, health
care is provided and funded by the government through tax payments. The government owns
many, but not all, hospitals and clinics in the country. Doctors may be government or private
employees who collect their professional fees from the government. This results in low cost per
capita since the government controls the health care services. Countries using the Beveridge plan
include Hong Kong, Great Britain, Spain, most of Scandinavia, New Zealand, and Cuba. The
Cuban government, for instance, uses total government control.
c. Strategic purchasing
In strategic purchasing, risk-pooling organizations use collected funds and pooled financial
resources to finance health care services for the members. The purchaser defines the substantial
part of the health provider's external incentives to develop the provider-user interaction and the
health serve delivery models.
WHO Health System Framework
In its World Health Report 2000, WHO released a single framework (Figure 2.1) with six
clearly defined building blocks and priorities which are necessary in strengthening health systems
and improving the overall health outcomes.

One building blocking is service delivery which refers to the timely delivery of quality
and cost-effective personal and non-personal health services. Another is health workforce which
includes individuals and groups working towards the achievement of the best health outcomes by
being responsive, fair, and efficient. The number of staff should be sufficient and fairly distributed
to ensure competency, responsiveness, and productivity. Information (health information system)
which analyzes, disseminates, and uses reliable and relevant information on health status,
determinants, and systems performance is also a valuable building block. Another important
building block is that of health products, vaccines, and technologies which are made accessible
through uninterrupted supply, well-managed pharmaceutical services, and education on proper use
of medication. Financing (health financing system) is a building block which takes care of the
funding for health care services to guarantee that people can use health services when needed
without fear of having not enough resources to pay for them. Lastly, leadership and governance
involves the task of ensuring effective stewardship of the entire health system. This building block
also covers the monitoring of the accountability of private and public health agencies, proper
system design, and appropriate regulation of health systems.
The Philippine Health System
Historical Background
The health reform initiatives carried out over the years in the Philippines were primarily
focused on these areas of concern: health service delivery, health regulation, and health financing.
These health reforms aimed at addressing issues such as poor accessibility, inequity, and
inefficiency Of the Philippine health system.
1. 1979: Adoption of Primary Health Care Strategy (LOI 949) - promoted participatory
management health care system.
2. 1982: Reorganization of DOH (EO 851) integrated the components of health care delivery
into its field operations.
3. 1988: The Generics Act (RA 6675) ushered the writing of prescriptions using the generic
name of the drug.
4. 1991: Local Government Code (RA 7160) transferred providing health service to the local
government units.
5. 1995: National Health Insurance Act (RA 7875) — instituted a national health insurance
mechanism for financial protection with priority given to the poor
6. 1999: Health Sector Reform Agenda ordered the major organizational restructuring of the -
DOH to improve the way health care is delivered, regulated, and financed
7. 2005: FOURmula One (Fl) for Health adopted an operational framework to undertake reforms
with speed, precision, and effective coordination and to improve the Philippine health system
8. 2008: Universally Accessible and Quality Medicines Act (RA 9502) — promoted and
ensured access to affordable quality drugs and medicines for all
9. 2010: Kalusugang Pangkalahatan or Universal Health Care (AO 2010-0036) - provided
universal health coverage and access to quality health care

Leadership and Governance

The Department of Health (DOH) is mandated to provide the appropriate direction
standards for the nation's for the health care industry. Its other tasks include (1) the development
of plans, guidelines and standards for the health sector; (2) technical assistance; (3) capacity
building; (4) advisory seryices for disease prevention and (5) control of medicel supplies and
vaccines,
DOH coordinates its national health programs through the local government units (LGUs).
LGUS take care of their own health services and are given autonomy under the Local Government
Code (LGC) 1991 (R.A.7160). 78 provincial governors, 138 city mayors, 1,496 municipal mayors,
and 42,025 barangay chairpersons compose the local government units of the 'Country (NSCB,
2010).
In terms of administration, LGUs are grouped into 17 regions. Although they operate in a
decentralized system, LGUs are under the supervision of the DOH regional health offices. The
provincial government is tasked to provide health services through provincial and district hospitals.
The city and municipal governments rely on public health and primary health care centers for their
primary care. (For a detailed organizational structure of the Philippine health sector, see The
Philippines Health System Review (2011) published in Health System in Transition, vol. 1, no. 2.)
DOH is duty-bound to:
1. develop policies and programs for the health sector,
2. provide technical assistance to its partners,
3. encourage performance of the partners in the priority health programs,
4. develop and enforce policies and standards
5. design programs for large segments of the population
6. provide specialized and tertiary level care.

Figure 2.2 The Philippine Health System (Alliance for Improving Health Outcomes, Inc. 2017)
 Under the decentralized or devolved structure, the state is represented by national offices
and LGUs, with provincial, city, municipal, and barangay or village offices. DOH, LGUs, and the
private sector participate, cooperate, and collaborate in the care of the population. Before
devolution, the national health system consisted of a three-tiered system under the direct control
of the DOH: (1) the tertiary hospitals at the national and regional levels; (2) the provincial and
district hospitals and city and municipal health centers; and (3) the barangay (village) health
centers.
With the enactment of the LGC of 1991, the government health system now consists of
basic health services—including health promotion and preventive units—provided by cities and
municipalities provincial and province-run district hospitals of varying capacities, and mostly
tertiary medical centers, specialty hospitals, and a number of re-nationalized provincial hospitals
managed by DOH.

Directions of the Philippine Health Sector

1. The Philippine Health Agenda 2016-2022 (DOH Administrative Order 2016-0038)

This agenda adopts the slogan "All for Health Towards Health For All" as the rallying point
for its vision of a Healthy Philippines by 2020. It expanded the scope of the Universal Health Care
(UHC) directions, particularly through a whole-of-government approach. With this agenda, the
health system guarantees:
a. population- and individual-level interventions for all life stages that promote health and
wellness, prevent and treat the triple burden of disease, delay complications, rehabilitation,
and provide palliation for both the well and the sick;
b. access to health interventions through functional service delivery networks (SDNs); and
c. financial freedom when accessing these interventions through Universal Health Insurance.

2. The Philippine Development Plan 2017—2022

This is the first of the four key medium-term plans to translate the vision of a "matatag
maginhawa, at panatag na buhay" for the Filipinos and the country.
3. NEDA AmBisyon Natin 2040
A product of the Philippine Development Plan 2017—2022, this collective long-term plan e
nvisions better life for the Filipinos and the country in the next 25 years by formulating
policies and implementing programs and projects to attain this AmBisyon. This plan focuses on
four areas: building a prosperous, predominantly middle-class society where no one is poor;
promoting a long and healthy life; becoming smarter and more innovative; and building a high-
trust society.
4. Sustainable Development Goals 2030
Also known as the 2030 Agenda, this compilation of 17 global development goals targets
to end poverty, fight inequality and injustice, and confront issues involving climate change.

Key Points to Remember

 Health system combines resources, organization, financing, and management to deliver
health services to the population. According to the World Health Report (WHO, 2000),
health system is defined as "all the organizations, institutions, resources, and people whose
primary purpose is to improve health."
 The primary goals of a health system are improved health outcomes (attaining the best
average level health care for the entire population by minimizing disparities), more
responsive health system (meeting the people's expectations of and satisfaction from
health service delivery), and more equitable health care financing (protecting each
individual from financial risks).
 The four functions of the health system are health services provision (for appropriate and
cost effective health delivery); health service inputs (for generating human resources,
technology, and capital); health financing (by revenue collection, risk pooling, and
strategic purchasing); and stewardship and initiatives (to strengthen governance,
accountability, and responsiveness).
 A health system can be analyzed in its totality by using a framework consisting of six
building blocks, i.e., leadership and governance, health financing, health workforce, health
products, vaccines, and technologies, health information, and service delivery.
 The Department of Health (DOH) is the lead agency for Philippine health care. According
to its mandate (E.O. No. 119, Sec. 3), the DOH shall be responsible for the (1) formulation
and development of national health policies, guidelines, standards, and manual of
operations for health services and programs; (2) issuance of rules and regulations, licenses,
and accreditations; (3) promulgation of national health standards, goals, priorities, and
indicators; and (4) development Of special health programs and projects, and advocacy
for legislation on health policies and programs.
 Lesson 3: Primary Health Care and the Philippine Health Care
Delivery System
Health Care
According to the Alma-Ata Declaration of 1978, health is a fundamental human right. It
most important global goal is for humans to reach the optimal level of their health; this requires
not the action of the health sector but the collaboration among other sectors such as those in the
social and economic sectors.
Meanwhile, a common concern of many country countries, status has which the including
duty is not and socially, both responsibility developed economically, and to institute developing
ones is the gross inequality in the people's health acceptable. Thus, the government of each
measures to promote and protect its people's health, and thus achieve a better quality of life.
For better understanding, the following concepts under health care are defined (as cited
in DeDios, lid):
1. Health care system is defined by Miller & Keane (1987) as "an organized plan of
health services."
2. Health care delivery, as defined by Williams & Tungpalan (1981), is "the rendering
of health care services to the people."
3. Health care delivery system, also as defined by Williams & Tungpalan (1981), is "the
network of health facilities and personnel which carries out the task of rendering health care
to the people."

Primary Health Care

As cited by WHO, the Alma-Ata Declaration defines primary health care as important
health care derived from scientifically sound and socially acceptable methods. It must be
universally accessible to all individuals and is based on what the community and country can
provide.
As an approach, the primary health care (PHC) deals with social policy which targets
health equity PHC has the essential elements and objectives that ensure attainable better health
services for all.
The ultimate goal of primary health care is better health for all. WHO has identified five
key to achieve this goal. These are

1. universal coverage to reduce exclusion and social disparities in health,

2. service delivery organized around people's needs and expectations,
3. public policy that integrates health into all sectors,
4. leadership that enhances collaborative models of policy dialogue, and
5. increased stakeholder participation.
Essential Elements of Primary Health Care

Below are the eight (8 elements of primary health care):

1. Education concerning prevailing health problems and the methods of identifying, preventing'
controlling them
2. Locally endemic disease prevention and control
3. Expanded program of immunization against major infectious diseases
4. Maternal and child health care including family planning
5. Essential drugs arrangement
6. Nutritional food supplement, an adequate supply of safe, and basic nutrition
7. Treatment of communicable and non-communicable disease and promotion of mental health
8. Safe water and sanitation
Other elements of Primary Health Care
1. Expended options of immunizations
2. Reproductive health needs
3. Provision of essential technologies for health
4. Health promotion
5. Prevention and control of non-communicable diseases
6. Food safety and provision of selected food supplements

Principles of Primary Health

A conceptual shift in health care calls attention to the fact that primary health care should
be integrated, and its principles guide the functions of the system as a whole. Having a systems
perspective bridges the conflict between primary h th care as a distinguished level of care and as a
holistic approach to the provision of health services.
The health system should also consider the principles of the Alma-Ata Declaration and other
intersectoral approaches. It should cover broader health issues of populations while reinforcing
public health functions. It should come up with programs that provide care and prevent diseases
and provision for services especially for the poor and marginalized groups. Finally, it should be
able to monitor programs for continuous improvement.
The basic objectives to launch and sustain primary health care as part of.the
comprehensive health system are as follows:
1. Improve the level of health care of the community
2. Promote favorable population growth structure
3. Reduce the morbidity and mortality rates especially among infants and children
 4. Reduce prevalence of preventable, communicable, and other diseases
5. Improve basic sanitation
6. Extend essential health services especially to underserved sectors
7. Develop the capability of the community to become self-reliant
8. Encourage the contribution of other sectors to the social and economic development
of the community
9. Provide equitable distribution of health care
10. Ensure community participation and monitor adequacy and distribution of health
workers who are supported locally and at the referral levels
11. Recognize that the formal health sector needs other sectors in the promotion of health
(multi-sectoral approach)
12. Use the appropriate technology which are accessible, feasible, affordable,and culturally
acceptable to the community

Management of Primary Health Care

Health care managers usually carrv out the following functions in the process of management.
1. Planning - This means setting priorities and determining performance targets. Managers
are usually required to set a direction and determine what needs to be accomplished.
2. Organizing - This refers to designing the organization or the specific division, unit, or
service for which the manager is responsible. Furthermore, it means designating reporting
relationships and intentional patterns of interaction, determining positions and teamwork
assignments, and distributing authority and responsibility.
3. Staffing - This function refers to acquiring and retaining human resources, and developing
and maintaining the workforce through various strategies and tactics.
4. Controlling - This function refers monitoring staff activities and performance and taking
the appropriate actions for corrective actions to increase performance.
5. Directing - This focuses on initiating action in the organization through the effective
leadership, motivation, and communication of managers.
Below are the management principles in relation to organizing:
1. Authority, responsibility, and accountability
a) Authority refers to the formal and legitimate right of a manager to issue orders, make decisions,
and allocate resources to achieve desired outcomes of the organization.
b) Responsibility is the duty of the employee to perform the assigned tasks and activities.
c) Accountability means reporting and justification of task outcomes to higher management by
those people with authority.
2. Types of authority
a) Line authority managers issue orders to their subordinates and are responsible for the results.
b) Functional authority is for managers that have power only over a specific set of activities.
c) Staff authority is given to specialists in their areas of expertise. The staff manager simply
advises, recommends, and counsels.
3. Centralization, decentralization, and formalization
a) Centralization refers to the concentration of planning and decision-making to the top of the
organization.
b) Decentralization refers to the delegation of planning and decision-making to the lower
branches of the organization.
c) Formalization refers to a written documentation provided for the direct control of the
employees
4. Staffing
a) Assign individuals to respective positions identified in a management plan
b) Assess required competencies through
• identification of the key result areas (KRA’s) per major activity
• determination of competencies and qualifications
c) Recruit qualified personnel
d) Improve existing services and programs by
• reviewing and adjusting the requirements accordingly
• matching the competency requirements vis-a-avis the responsible personnel assigned to the
activity

The Philippine Health Care System

According to Dizon (1977), the Philippine Health Care System is “a complex set of organizations
interacting to provide an array of health services." It has progressed due to challenges encountered
over time. In 1991, the local government units (LGUs) took over the management of health service
delivery but the issue of fragmentation has not been absolutely addressed. Health workforce has
to deal with the pressing issues of underemployed workers, limited resources, and unequal
distribution. Meanwhile, the private sector which is said to comprise 50% of the overall health
system is strongly involved in improving the delivery of health services, but the government's
power to regulate should be optimized.

The Department of Health Mandate

As Specified in Executive Order No. 119, Sec: 3, the Ministry of Health [now Department of
Health (DOH)] has the responsibility to create, plan, implement, and systematize national health
policies, advocacies, and programs. Its primary function is to promote, protect, and preserve or
restore people's health by giving health services and by monitoring and motivating health service
providers. Moreover, it is responsible for the issuance Of health-related licenses and accreditations
and disseminating information about national health indicators.

Vision
DOH vision by 2030 states
A global leader for attaining better health outcomes, competitive and responsible health care
system, and equitable health financing
Mission
DOH mission states
To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to
lead the quest for excellence in health

Levels of Health Care Facilities

Below are the levels ofhealth care facilities according to Williams & Tungpalan (as cited in
DeDios, lid):
1. Primary Level of Health Care Facilities
The primary level of health care facilities refers to the following:
a. Units operated by the DOH which include the rural health units, their respective sub-
centers chest clinics, malaria eradication units, and schistosomiasis control units;
b. Puericulture center operated by the League of Puericulture Centers;
c. Units operated by the Philippine Tuberculosis Society such as the tuberculosis clinics and
hospitals;
d. Clinics operated by the Philippine Medical Association;
e. Clinics operated by large industrial firms for their employees;
 f. Health centers and community hospitals operated by the Philippine Medical Care
Commission; and
g. Other health facilities operated by voluntary religious and civic groups.
2. Secondary Level of Health Care Facilities
The secondary level of health care facilities includes the smaller and non-departmentalized
hospitals. These are emergency and regional hospitals where adequate treatments are offered for
patients with symptomatic stages of diseases.

3. Tertiary Level of Health Care Facilities

Included in the tertiary level are specialized national hospitals which offer highly technological
and sophisticated services. Patients who are afflicted with life-threatening diseases requiring
highly technical and specialized knowledge, facilities, and personnel are treated here.

Levels of Primary Health Care Workers

I. Grassroot or Village Health Workers
a. They are the initial links of the community to health care.
b. They provide preventive health care measures and simple curatives to promote a healthy
c. They encourage programs/activities such as food production programs to improve the
socioeconomic level of the community.
d. They are the volunteers, community health workers, or traditional birth attendants.
2. Intermediate Level Health Workers
a. They are the first source of professional health care.
b. They attend to health problems which are already beyond the competence of the village
workers.
c. They provide supervision, training, supplies, and services that provide support to front-line
health workers.
d. They are medical practitioners, nurses, and midwives.
3. First-Line Hospital Personnel
a. When hospitalization is required, they serve as the backup health service providers.
b. The intermediate level health workers or village health workers are in close contact with them.
c. They are the physicians with specialty, nurses, dentist, pharmacists, and other health
professionals.
 The categories of health workers are affected by certain factors such as
l. the availability of health manpower resources,
2. the presence of health care concerns and needs of the locality, and
3. the issue of financial and political feasibility.

Key Points to Remember

 Health is a fundamental human right as cited in the Alma-Ata Declaration of 1978
 Reaching the highest possible level of health is important worldwide.
 Primary health care (PHC) is essential health care made universally accessible through full
participation of health care providers and at a cost that the community and the country can
afford.
 The ultimate goal of primary health care is better health for all. The principles of primary
health care should guide the functions of the system as a whole.
 Management of primary health care includes planning, organizing, staffing, controlling,
and directing. Health care facilities are categorized into primary, secondary, and tertiary
levels. Primary health care workers are categorized as grassroot or village health workers,
intermediate level health workers, and first-line hospital personnel.
 The Philippine health care system has progressed due to many challenges through time.
The private sector has been strongly engaged but government regulation should be
optimized.
 The primary function of the Department of Health (then Ministry of Health) indicated in
EO no. 119 is to promote, protect, preserve, or restore people's health by giving health
services and monitoring health service providers.
LESSON 4- OVERVIEW OF HEALTH INFORMATICS
Health Information Technology
The dawn of the information age has resulted in the generation of huge amounts of routine data,
particularly in health care, which can become perplexing to process and analyze. This is the challenge for
health informatics—to make sense of large amounts of data while ensuring that the processes are valid and
secure.

The transition from a manual to a more advanced health information system is an overarching issue
for providers of health care, managers, policymakers, researchers, and patients alike. While there are benefits,
there are also undeniable disadvantages. One innovation that manages health information for better service
delivery is health information technology.

Rouse (2016) defines health information technology (HIT) as "the area of IT involving the design,
development, creation, use, and maintenance of information systems for the health care industry. Automated
and interoperable health care information systems are expected to improve medical care, lower costs, increase
efficiency, reduce error, and improve patient satisfaction while also optimizing reimbursement for ambulatory
and in-patient health care providers."

Health information technology vows to provide innovation to health care delivery and connection
among users and stakeholders in the e-health market. Systems such as electronic health records, decision
support systems, and personal health records are promising and are becoming widely deployed worldwide
(Kushniruk & Borycki, 2017).

(venn diagram)

Health Care Software Systems

Rouse (2016) enumerates the following types of health information technology:

An electronic health record (EHR) is also called an electronic medical record (EMR).
It is one of the fundamental components of health information technology infrastructure. EHR is the patient's
official health record in digital form and this information is shared across multiple health care providers and
agencies. The other key elements are the personal health record (PHR) and the health information exchange
(HIE). A PHR is a person's self-maintained health record while the HIE is the health data clearinghouse which
is comprised of health care organizations with interoperability pact to share data among their health
information technology systems.

In the United States, since the inception of the HITECH Act of 2009, the use and implementation of
EHR systems have increased dramatically. Hospitals and physicians using the government-certified EHR
systems meet the meaningful use criteria and are qualified to receive incentives. The said criteria is regulated
under the Office of the National Coordinator (ONC) for health IT which certifies approved IT technology use
under the federal reimbursement program and Centers for Medicare & Medicaid Services (CMMS).
However, meaningful use is changing due to the Medicare Access and Children's Health Insurance Plan
Reauthorization Act (MACRA) which is a law on value-based reimbursement system passed by the US
Congress in 2015.

There are two widely used types of health information technology, the picture archiving and
communication systems (PACS) and vendor neutral archives (VNA). These two help manage and store the
patients' medical images.
 PACS and VNAs integrate radiology into the main hospital workflow. Radiology used to be the
primary repository for medical images. Presently, other specialties such as cardiology and neurology are also
among the large-scale producers of clinical images. VNAs can also be installed for the purpose of merging
stored imaging data from various departments into a multi-facility health care system.

Health Information Ecosystem

The Healthcare Information and Management Systems Society (2017) defines a health
interoperability ecosystem as a composition of individuals, systems, and processes that share, exchange, and
access all forms of health information, including discrete, narrative, and multimedia. Individuals, patients,
providers, hospital/health systems, researchers, payors, suppliers, and systems are potential stakeholders within
such an ecosystem. Each is involved in the creation, exchange, and use of health information and/or data.

An efficient health interoperability ecosystem provides an information infrastructure that uses

technical standards, policies, and protocols to enable seamless and secure capture, discovery, exchange, and
utilization of health information.

Health Informatics in the Cloud

The role of cloud technology is undeniably significant in our everyday lives. Cuhently, 83 percent of health care
organizations are making use of c16ud-based applications, and it is changing the landscape of the health care
system and health informatics. However, both benefits and threats exist (University of Illinois, 2014).

Advantages of Cloud Technology

1. Integrated and Efficient Patient Care

Cloud technology offers a single access point for patient information which allows multiple doctors to review
laboratory results or notes on patients. Physicians can spend more time deciding and performing patient
treatment instead of waiting for information from different departments.

2. Better Management of Data

The accumulation of electronic health records will allow more meaningful data mining that can better assess
the health of the general public. More data can mean more opportunities to identify trends in diseases and
crises.

Disadvantages of Cloud Technology

1. Potential Risks to Personal Information

The strength of cloud technology is also the very same characteristic that makes it vulnerable to data breaches.
The information contained within medical records may be subjected to theft or other violations of privacy and
confidentiality. Fortunately, safeguards may be put in place to minimize such threats such as encryption,
proper data disposal, and other security features.

2. Cloud Setup Seems Cumbersome

The transition from a traditional to an automated system might be difficult for some members of health care
organizations that may not be familiar with cloud technology. This technology, however, will be adopted by
more institutions in the future. With proper education and illustration of its function, hesitant practitioners may
be able to see its advantages.
Health Informatics in the Philippines
Health informatics is the application of both technology and systems in a health care setting. It has
been loosely practiced in the Philippines since the 1980s. Practitioners who had access to IBM (International
Business Machines Corporation) compatible machines used word processors to store patient information. Since
then, significant milestones in health informatics have occurred over the years, one of which is the Community
Health Information Tracking System (CHITS), a Linux, Apache, MySQL, PHP-based system released under
the general public license (GPL). CHITS was named finalist at the Stockholm Challenge 2006 and one of top
three e-government projects in the Philippines by the Asia Pacific Economic Cooperation (APEC) Digital
Opportunity Center (ADOC).

CHITS is an electronic medical record (EMR) developed through the collaboration of the
Information and Communication Technology community and health workers, primarily designed for use in
Philippine health centers in disadvantaged areas, It is currently utilized in 111 government health facilities.
What used to be manually done, eg., looking up a patient's record for four to five minutes, can now be
executed within a couple of seconds. The implementation of CHITS has indeed resulted in higher efficiency
rate among health workers since more time can be spent in providing patient care (Philippine Council for
Health Research and Development, 2012).

Despite the development, health informatics in the Philippines still suffers from various issues that
hamper progress, one of these is the lack of interest in the field. Health informatics is seen more as a novelty
rather than as a profession. When professional and economic constraints come into play, priorities shift
towards clinical responsibilities at the expense of health informatics as a discipline.

Another issue is that many decision-makers do not use the benefits of information technology in the
health sector. The large initial expenditure for a health information system remains another barrier to the
integration of IT in the Philippine health care system (Marcelo, 2012).

KEY POINTS TO REMEMBER

 Health information technology (HIT) involves the development and management of health
information for improved health service delivery.
 The electronic health record (EHR) is the central component of the HIT infrastructure.
 Picture archiving and communication systems (PACS) and vendor neutral archives (VNAs) are two
widely used types of HIT that help health care professionals store and manage patients' medical
images.
 An efficient health interoperability ecosystem provides an information infrastructure that uses
technical standards, policies, and protocols to enable seamless and secure capture, discovery,
exchange, and utilization of health information.
 The advantages of health informatics in the cloud are integrated and efficient patient care and better
management of data.
 Despite the development, health informatics in the Philippines still suffers from various issues that
hamper progress, such as the lack of interest in the field. Another issue is that the benefits of
information technology do not seem apparent to many decision-makers in the health sector.
LESSON 5- HEALTH INFORMATION SYSTEMS
Health Information Systems
Health informatics is the application of both technology and systems in a health care setting. While
health information technology focuses on tools, health information systems cover the records, coding,
documentation, and administration of patient and ancillary services.

Concerns about the cost and quality of health care are among the motivating factors why health
information systems are increasingly implemented across health industries all over the world. The combination
of elements in a health information system enables the provision of more efficient and effective health care
services. The components of a health information system are correlated and translated into harmonious
operations.

The health information systems (HIS) cover different systems that capture, store, manage, and
transmit health-related information that can be sourced from individuals or activities of a health institution.
These include disease surveillance systems, district level routine information systems, hospital patient
administration systems (PAS), human resource management information systems (HRMIS), and laboratory
information systems (LIS).

The information collected from a well-functioning HIS is very useful in policymaking and decision
making of health institutions and becomes the basis in creating program action. This translates to efficient
resource allocation at the policy level, and improvement of the quality and effectiveness of health at the
delivery level.

HIS should be sustainable, user-friendly, and economical. Health care personnel should be educated
on the use of the routine data collected from the system and the significance of good quality data in improving
health (Pacific Health Information Network, 2016).

Role and Function of Health Information Systems

Sheahan (2017) defines health information systems (HIS) as a mechanism which keeps track of all
data related to the patient such as patient's medical history, contact information, medication logs, appointment
schedule, insurance information, and financial account including billing and payment. The roles that a well-
implemented HIS can perform in improving health services are as follows:

1. Easier access to files

The systems have revolutionized the collection and management of patient information. The need for
a hardcopy of the patient's medical records becomes optional as the systems are electronic.

2. Better control
Only authorized personnel can have access information on the patient's health. Doctors may be given
permission to update patient information while a receptionist may only have the authority to update a patient's
appointments.

3. Easier update
After creation of the record, patient information can be accessed and reviewed any time and copies
can be printed or released to the patient upon request.
4. Improved communications
HIS assists communication among doctors and hospitals. However, medical professionals must
adhere to regulations on patient privacy and security to ensure that information is kept confidential and safe
from unauthorized access.

A good health information system delivers accurate information in a timely manner, enabling decision- makers
to make informed choices about the different aspects of the health institution, from patient care to annual
budgets. It also upholds transparency and accountability due to easier access to information.

Components of Health Information Systems

The Health Metrics Network (HMN), in its Framework and Standards for Country Health
Information Systems (2008), defines health information systems as consisting of six components:

(diagram)

Figure 5.1 Six Elements of HIS

1. Health information systems resources

These include the framework on legislation, regulation, planning, and the resources required for the
system to be fully functional (e.g., personnel, logistics support, financing, ICT, and the component's
coordinating mechanism).

2. Indicators
The basis of the HIS plan and strategy includes indicators and related targets such as determinants of
health, health system inputs, outputs, and outcomes; and the health status.

3. Data sources
Data sources are divided into two main categories: (1) population-based approaches such as civil
registration, censuses, and population surveys and (2) institution-based data such as individual records,
resource records, and service records. Occasional health surveys, research, and information produced by
community-based organizations may not be directly classified under the main categories, but they may provide
useful information.

4. Data management
Data management refers to the handling of data, starting from collection and storage to data flow and
quality assurance, processing, compilation, and data analysis.

5. Information products
Data is transformed into useful information that serves as evidence and provides insight crucial to
shaping a health action.

6. Dissemination and use

HIS enhances the value of health information by making it readily available to policymakers and data
users.
These six components of health information systems can be categorized into inputs, processes, and outputs.

Inputs refer to the health information system resources. These resources include health, institutional
coordinations and leadership, health information policies, financial and human resources, and infrastructures.

The indicators, data sources, and data management form the process in HIS. Core indicators are
needed as bases for program planning, monitoring, and evaluation. Population- and institution-based sources
are also essential for decision-making as they provide guide to health service delivery. Importantly, these data
must be accessible and understandable by users and policymakers.

Outputs refer to the transformation of data into information that can be used for decision- making
and to the dissemination and use of such information.

Different Data Sources for Health Information Systems

Demographic Data

Administrative Data Health

Risk Information Health

Status

Patient Medical History

Current Medical Management

Outcomes Data

Figure 5.2 Sources of Information for HIS

Donaldson and Lohr (1994) explain that a comprehensive database for health information systems include the
following:

1. Demographic data refers to the facts about the patient which include age and birthdate, gender, marital
status, address of residence, race, and ethnic origin. Information on educational background and employment is
also recorded along with information on immediate family members to be contacted during emergency.

2. Administrative data includes information on services such as diagnostic tests or out-patient procedures,
kind of practitioner, physician's specialty, nature of institution, and charges and payments.

3. Health risk information records the lifestyle and behavior (e.g., use of tobacco products or engagement in
strenuous activities) of a patient and facts about his or her family's medical history and other genetic factors.
This information is used to evaluate the patient's propensity for different diseases.
4. Health status refers to the quality of life that a patient leads which is crucial to his or her health. This shows
the domains of health which include physical functioning, mental and emotional wellbeing, cognitive
functioning, and social functioning. It also shows one's perception of his or her health in comparison with that
of his or her peers.

5. Patient medical history gives information on past medical encounters like hospital admissions,
pregnancies and live births, surgical procedures, and the like. It also includes previous illnesses and family
history (e.g., alcoholism or parental divorce).

6. Current medical management reflects the patient's health screening sessions, diagnoses, allergies
(especially on medications), current health problems, medications, diagnostic or therapeutic procedures,
laboratory test, and counseling on health problems.

7. Outcomes data presents the measures of aftereffects of health care and of various health problems. These
data usually show the health care events (e.g., readmission to hospital, unexpected complications or side
effects) and measures of satisfaction with care. Outcomes directly reported by the patient after treatment will
be most useful.

KEY POINTS TO REMEMBER

 Health Information systems (HIS) refer to systems that capture, store, manage, and transmit health-
related information that can be sourced from individuals or activities of health institutions.
 HIS improves the delivery of health services because it ensures easier file access, better control,
update, and improved communications.
 The components of health information systems are health information system resources (inputs);
indicators, data sources, and data management (processes); and transformation of data into
information, and its dissemination and use (outputs).
 The different data sources are demographic data, administrative data, health risk information, health
status, patient medical history, current medical management, and outcomes data.
LESSON 6- HEALTH MANAGEMENT INFORMATION SYSTEM
Health Management Information System

Traditionally, health care administrations have been managed manually, starting from patient
registration to consultation. The creation of documents proved to be time-consuming and posed the risk of
having duplicate records. Improper storage of these documents was also a concern because of difficulty in
retrieval and the high cost of maintaining proper storage. Getting an overview of the number of patients visiting
the hospital, or consolidating the nature of problems that need immediate action, and providing pertinent
reports were very difficult to achieve. Tools such as snapshots and dashboard which are necessary in the
analysis of the performance of hospitals were unavailable.

Hospitals using the traditional manual process do not have real-time data and delays in the receipt of
data pose a challenge to evidence-based program management. Accurate and real-time records of equipment
and drugs could not be obtained in a timely manner resulting in problems in accountability, monitoring of
expiry dates, stocks, and auto indenting. Inventory of medicine and equipment was a tedious task due to lack of
standards in filing names and codes in the institution.

The need to enhance the management of health care services and to have real-time data to monitor the
hospital performance thus calls for a health information management system that will address these concerns.

As defined by the World Health Organization (2004), health management information system
(HMIS) is "specially designed to assist in the management and planning of health programmes, as opposed to
delivery of care." The health component of HMIS refers to clinical studies to understand medical
terminologies, clinical procedures, and database processes; management refers to the principles that help
administer the health care enterprise; and information system refers to the ability to analyze and implement
applications for efficient and effective transfer of patient information. An HMIS is one of the six building
blocks essential for health system strengthening. It is a data collection system specifically designed to support
planning, management, and decision-making in health facilities and organizations.

HMIS is a set of integrated components and procedures organized with the objective of generating
information that will improve health care management decisions at all levels of the health system. It is a
routine monitoring system that evaluates the process with the intention of providing warning signals through
the use of indicators. At the health unit level, HMIS is used by the health unit in- charge and the Health Unit
Management Committee to plan and coordinate health care services in their catchment area.

HMIS was developed within the framework of the following concepts (Republic of Uganda Ministry
Of Health Resource Centre, 2010):
 The information collected is relevant to the policies and goals of the health care institution, and to the
responsibilities of the health professionals at the level of collection.
 The information collected is functional as it is to be used immediately for management and should
not wait for feedback from higher levels.
 Information collection is integrated for there is one set of forms and no duplication of reporting.
 The information is collected on a routine basis from every health unit.
Roles of HMIS
The major role of HMIS is to provide quality information to support decision-making at all levels of
the health care system in any medical institution. In addition to encouraging the use of health information in
hospitals, it also aims to aid in the setting of performance targets at all levels of health service delivery and to
assist in assessing performance at all levels of the health sector (Republic of Uganda Ministry Of Health
Resource Centre, 2010).

An HMIS needs to be complete, consistent, clear, simple, cost-effective, accessible, and confidential
(Janneh, 2002). It should be complete with all information but avoiding duplication and consistent in assigning
definitions to similar information from various sources. It should also be simple to use and clear as to what is
measured by the elements. The eligible users must have access and should be able to use the system with ease.
The confidentiality of patient information and data privacy should always be a top priority. While providing all
these benefits, the system must prove its cost-effectiveness through its operations.

Functions of HMIS
The information from an HMIS can be used in planning, epidemic prediction and detection,
designing interventions, monitoring, and resource allocation (Republic of Uganda Ministry of Health Resource
Centre, 2010).

Historically, all information systems, including HMIS, are built upon the conceptualization of three
fundamental information-processing phases: data input, data management, and data output. Each phase comes
with elements (Tan, 2010) that perform specific functions.

1. Data input includes data acquisition and data verification.

a. Data acquisition refers to the generation and collection of data through the input of standard coded
formats (e.g., bar codes) to assist in the faster mechanical reading and capturing of data.
b. Data verification involves data authentication and validation. The authority, validity, and
reliability of the data sources help ensure quality of gathered data.

2. Data management, also called processing phase, includes data storage, data classification, data update, and
data computation.
a. Data storage includes preservation and archiving of data. It is advisable that data which are no
longer actively used should be archived. At times, it is mandatory and part of legislation.
b. Data classification is also called data organization which sets the efficiency of the system. Key
parameters should be used for data classification schemes for easier data search.
c. Data computation requires various forms of data manipulation and data transformation (e.g.,
mathematical models, linear and nonlinear transformation, statistical and probabilistic
approaches, and other data analytic processes). This function allows data analysis, synthesis, and
evaluation so that data can be used not only for decision-making but also for other tactical and
operational use.
d. Data update facilitates new and changing information and requires constant monitoring. For
HMIS, the mechanism for data maintenance must be in place for updating changes for manual or
automated transactions.
3. Data output includes data retrieval and data presentation.

a. Data retrieval pertains to the processes of data transfer and data distribution. The transfer process
considers the duration of transmittal of required data from the source to the appropriate end-user. The
economics of producing the needed information is a significant criterion.
b. Data presentation is the reporting of the interpretation of the information produced by the system.
Summary tables and statistical reports are expected but the use of visuals is encouraged especially for
high-level managerial decision-making because they provide a better intuitive perspective of the data
trend.

List of Functions of HMIS

Listed below are the possible functions in an HMIS with the corresponding type of information that
can be captured and tracked in the system (Behavioral Health Collaboration Solutions, 2006).
1. Client data relates to all the information of the client which is related to his or her
transactions, reports, and other information such as client billing data, clinical data, and other
client data.
2. Scheduling is observed to distribute resources to areas that need them. An example is linking
the schedule to the billing of the entity.
3. Authorization tracking focuses on monitoring of the authorized personnel and their use of the
authorized units.
4. Billing refers to the notification of the charges for the patient and other related documents
such as the compliant electronic claim.
5. Accounts receivable (A/R) management ensures that customers are properly notified about
their bill and will settle it accordingly. Data for A/R management include tracking aging of
unpaid services, tracking reasons for denials, and aged receivable report by payer source.
6. Reporting refers to reports issued by the entity which could be basic reports or report writer.
7. Medical record, also called an electronic health record (EHR), is a collection of digital
information about a patient. Aside from patient registration, the data could include
assessment, treatment plan, and progress/encounter notes.
8. Compliance refers to procedure that should be followed for the improvement of the
condition of the patient or the service provided such as treatment plan and progress note.
9. Financial data refers to information relating to the performance of the entity collected for
administering purposes. These include financial reports, general ledger, payroll, and accounts
payable.

Determinants of HMIS Performance Area

The determinants affecting the performance of an HMIS may be behavioral, organizational, and technical.

Behavioral determinants
The data collector and users of the HMIS need to have confidence, motivation, and competence to
perform HMIS tasks in order to improve the routine health information system (RHIS) process. The chance of
the task being performed is affected by the individual perceptions on the outcome and the complexity of the
task (Aqil, Lippeveld, & Hozumi, 2009). Lack of motivation and enough knowledge on the use of data has
been found to be a major drawback in the data quality and information use. Changing people's attitude towards
data collection and analysis is necessary in order to maximize the performance of the RHIS process (Routine
Health Information Network, 2003).
Organizational determinants
The important factors that affect the development of the RHIS process are the structure of the health
institution, resources, procedures, support services, and the culture within the organization (Aqil, Lippeveld,
& Hozumi, 2009). However, other factors which include lack of funds, human resources, and
management support contribute to the determinant of the RHIS process.

Having a system in place which supports data collection and analysis and transforms it into useful
information will help in promoting evidence-based decision-making. Thus, all components within the system
are ideal in making the RHIS perform better. An improved RHIS performance means an effective
organizational culture that promotes information use by collecting, analyzing, and using information to
accomplish the organization's goals and mission (Sanga, 2015).

Technical determinants
Technical factors involve the overall design used in the collection of information. It comprises the
complexity of the reporting forms, the procedure set forward in the collection of data, and the overall design of
the computer software used in the collection of information (Sanga, 2015).

PRISM Framework

The Performance of Routine Information Systems Management (PRISM) is a conceptual

framework that broadens the analysis of HMIS or RHIS by including the three determinants of HMIS
performance, namely:
 Behavioral determinants - knowledge, skills, attitudes, values, and motivation of the people who
collect and use data,
 Organizational/environmental determinants - information culture, structure, resources, roles, and
responsibilities of the health system and key contributors at each level, and
 Technical determinants - data collection processes, systems, forms, and methods.

This framework identifies the strengths and weaknesses in certain areas, as well as the correlations among
these areas. This assessment aids in designing and prioritizing interventions to improve RHIS performance,
which in turn improves the performance of the health system.
The PRISM framework, founded on performance improvement principles, defines the various components
of the routine health information system and their linkages to produce better quality data and continuous use of
information, leading to better health system performance and, consequently, better health outcomes (Aqil,
Lippeveld, & Hozumi, 2009).
KEY POINTS TO REMEMBER
 A health management information system (HMIS) is "specially designed to assist in the management
and planning ofhealth programs, as opposed to delivery of care (WHO, 2004)."
 The major role of HMIS is to provide quality information to support decision-making at all levels of
the health care system in any medical institution.
 Historically, all information systems, including HMIS, are built upon the conceptualization of three
fundamental information-processing phases: data input, data management, and data output. Each
phase comes with elements that perform specific functions. The eight elements are data acquisition,
data verification, data storage, data classification, data computation, data update, data retrieval, and
data presentation.
 The determinants affecting HMIS performance are behavioral, organizational, and technical.
 The PRISM (Performance of Routine Information Systems Management) framework defines the
various components of the routine health information system (RHIS) and their linkages to produce
better quality data and continuous use of information, leading to better health system performance
consequently, better health outcomes.
LESSON 7 HMIS MONITORING AND EVALUATION

HMIS Monitoring and Evaluation

A health management information system aims primarily at assisting in the planning and
management of a national health strategy plans; thus, continuous monitoring and evaluation is
necessary for it to be effective. By definition and function, monitoring and evaluation are
complimentary. Monitoring refers to the collection, analysis, and use of information gathered
from programs for the purpose of learning from the acquired experiences, accounting the resources
used both internal and external, and obtaining results and making decisions. These purposes
correspond to three functions: learning, monitoring, and steering. Meanwhile, evaluation is the
systematic assessment of completed programs or policies. The objective is to gauge the
effectiveness of the program so that adjustments can be made in areas that need improvement. An
evaluation has both a learning function in which the lessons learned need to be incorporated into
future proposals, and a monitoring function which means that the concerned parties review the
implementation of policy based on the objectives and resources.

Purpose of M&E
A robust monitoring and evaluation (M&E) system is required to assess the effect of an
integrated service delivery. Appropriate indicators, data collection systems, and data analysis to
support decision-making help guide the successful implementation of integrated services and
measure the effect on both service delivery and use of services (FP/Immunization Integration
Working Group, n.d.).

M&E Framework
A general framework of M&E of health system strengthening (HSS) was developed by
various global partners and countries. Derived from the Paris Declaration on aid harmonization
and effectiveness and the International Health Partnership (IHP+), this framework places health
strategy and related M&E processes of each country at the center. The strengthening of a common
country platform for the M&E of HSS is the core of the framework. In doing so, there is better
alignment and the monitoring of fundings for health systems is easy.
There are four components of the framework as provided by WHO, namely, the indicator
domains, data collection, analysis and synthesis, and communication use, intended for achieving
greater health impact. For monitoring medical services, indicators should be tracked to assess
processes and results associated with the various indicator domains. In this way, the strengths and
weaknesses of implementation are provided and can be used for troubleshooting in the system. In
terms of outcomes and impact indicators, the changes may not be directly caused by service
delivery efforts for there are other factors to consider. However, these data are still useful in
understanding the current health status and context within a country (FP/Immunization Integration
Working Group, n.d.).
It should be noted that shifts in outcome and impact indicators may not be directly
attributable to integrated service delivery efforts, as there are many other factors which influence
these indicators. However, where possible, it can be useful to collect these data in order to
understand the broader health context within a country, and the ways in which packages of
interventions can lead to impact over time (FP/Immunization Integration Working Group, n.d.).
M&E Plan
An M&E plan addresses the components of the framework and establishes the foundation
for regular reviews during the implementation of the plan for the national level. Local M&E
systems generate information for global monitoring based on the health sector review processes
which are considered key factors in monitoring the progress and performance of the entire system.
Medical institutions are monitored and evaluated through the assessment of reports, surveys,
HMIS, and other evaluation studies.
Specifically, the National Health Mission of India identifies strategies which help in the
successful implementation of the framework. The framework should (1) be localized, (2) address
the needs for multiple users and purposes, (3) facilitate the identification of indicators and data
sources, and (4) be able to use the M&E in disease-specific programs.

M&E and HMIS Indicators

An indicator is a variable which measures the value of the change in units that can be
compared to past and future units. The focus is on a single aspect of a program such as input,
output, among others. HMIS uses various indicators to monitor key aspects of health system
performance. The United States Agency for International Development (USAID) classifies these
indicators (Table 7.1) into five broad categories, namely, reproductive health, immunization,
disease prevention and control, resource utilization, and data quality.
Table 7.1 Categories of HMIS Key Indicators
Key Performance Area Key Indicator
Reproductive Health 1. Family planning acceptance rate
2. Antenatal care coverage
3. Proportion of deliveries attended by skilled health personnel
4. Proportion of deliveries attended by HEWs
Immunization 5. DPT-3 (PentavaIent-3) coverage (>1 child)
6. Measles Immunization coverage (>1 chiid)
Disease Prevention and 7. Malaria case fatality rate among patients under 5 years of age
Control
8. New malaria cases per 1,000 population
9. New pneumonia cases among children under 5 per 1,000
population of <5 yrs
10. TB case detection rate
11. TB cure rate
12. Clients receiving VCT services
13. PMTCT treatment completion rate
14. PLWHA currently on ART
Resource Utilization 15. Trace drug availability (in stock)
16. OPD attendance per capita
17. In-patient admission rate
18. Average length of stay (in-patient)
Data Quality 19. Bed occupancy rate
20. Reporting completeness rate
21. Reporting timeliness rate
Source: HMIS Information Use Training Manual (USAID, 2013)

Table 7.2 provides specific indicators, data sources, and purposes for tracking each
indicator for monitoring family planning and immunization service delivery and assessing the
integration of services. This table includes a variety of quantitative indicators coupled with
qualitative techniques in order to better understand the basics of the integration processes and
solicit feedback on the approach.

Table 7.2 Quantitative indicators for monitoring family planning/immunization integration

Indicator Data Source Purpose
INPUTS
Vaccine stockouts in a single HMIS, Service statistics Monitor vaccine stockouts.
month (YES/NO, by type of
vaccine)
Contraceptive stockouts in a HMIS, Service statistics Monitor contraceptive
single month (YES/NO, by stockouts.
type of contraceptive)
Number of service providers Training records Monitor reach of EPI/FP
trained in provision of EPI/FP integration training as an
integrated services input for effective integrated
service delivery.
OUTPUTS
Number of service delivery Service Statistics and Coverage of integrated
points offering integrated FP Supervision service delivery
and immunization services
Number of days per month Service Statistics and Availability of co-located
when both immunization and Supervision FP/ immunization services
family planning services are (Observation + Interviews)
offered at the same site
Number/percent of women Supplemental tracking Quality/continuity of
attending routine child column that can be added to implementation of integrated
immunization services who existing immunization service delivery
received information on register
family planning from a [Monitored for
vaccinator demonstration/pilot programs
only]
Number/percent of women Supplemental tracking Quality/continuity of
(with children <12months) column added to FP Ledger implementation of integrated
going for family planning [Monitored for service delivery
who receive information on demonstration/pilot programs
immunization from the family only]
planning provider
Number/percent of women Supplemental tracking Acceptance of FP referrals
attending routine child column added to provided by the vaccinator
immunization services who Immunization Ledger
[Monitored for
 accept a referral to family demonstration/pilot programs
planning services only]
Number/percent of women Comparison of supplemental Follow through on FP
attending routine tracking column added to referrals provided by the
immunization services who immunization ledger, and vaccinator
follow through on a FP supplemental tracking
referral from a vaccinator column added to FP ledger
[Monitored for
demonstration/pilot programs
only]
Number/percent of women Comparison of supplemental Follow through on
attending family planning tracking column added to FP immunization referrals
services who follow through ledger, and supplemental provided by the family
on referral to immunization tracking column added to planning provider
services from a family immunization ledger
planning provider [Monitored for
demonstration/pilot programs
only]
OUTCOMES
Number of children receiving Immunization ledger/HMIS, Use of immunization
DTP 1, DTP 3, measlesl, and and population-based survey services, dropout
DTP 1-3 dropout data
Immunization coverage for HMIS and population-based Percentage of children <12
DTPI, DTP3, and measlesl Survey Data months in a given population
who have received DTPI and
DTP3
Number of new family Family Planning Uptake of family planning
planning acceptors by method ledger/HMIS services
type and demographic/age
group
Contraceptive prevalence Population Survey Data Contraceptive use within a
rate given population
Total financial cost of inputs Program data/Special costing Cost of inputs required for
required to integrate FP and studies integration. This may be
immunization services (per helpful in planning for
facility, per client exposed, decisions related to
per new FP acceptor) sustainability and scale-up of
integrated services.
IMPACT
Maternal, infant, and child Studies on maternal and Measure improvement in
mortality rates infant mortality health status.
1
In many countries measles coverage is higher than DTP3 coverage, even though measles is supposed to
be given later. Analysis and interpretation of findings for measles coverage should be done within the
context of individual country circumstances.
Source: Key Considerations for Monitoring and Evaluating Family Planning and Immunization
Integration Activities (FP/lmmunization Integration Working Group, n.d.)
HMIS Indicators and Health Programs
HMIS is a source of routine data necessary for monitoring different aspects of various
health programs implemented in a country. The HMIS indicators should be carefully selected to
meet the essential information necessary for monitoring the performance of various health
programs and services and to present an overview of available health resources.
This section explains the relationship of HMIS indicators and some of the health programs
communicable and non-communicable diseases. These disease data provide an in-depth
Understanding of how HMIS can be used for monitoring program performance and how it
encourages similar in-depth analysis for all health programs and services such as maternal survival
intervention, child mortality and child survival intervention, and Stop TB program.

Maternal Survival Interventions

The fifth millennium development goal targets to reduce the maternal mortality ratio by 75
percent and to achieve universal access to reproductive health. Despite this set goal, none of the
maternal survival intervention alone can reduce the maternal mortality rate. As Campbell and
Graham (2006) explained the complexity of the country Contexts and maternal health determinants
makes it complicated to choose the best strategies in achieving this goal. However, they found that
packaging of health facility-oriented interventions is highly effective and has high coverage of the
intended target group.
In order to routinely monitor the progress towards implementation of a highly effective
package of maternal survival interventions, HMIS is designed to provide some of the core input,
process, and output indicators.

The HMIS indicators are related to the following:

1. pregnancy care interventions

 1st antenatal care attendances
 4th antenatal care attendances
 Cases ofabnormal pregnancies attended at out-patient departments (OPD) of health
facilities
 Institutional cases of maternal morbidity and mortality due to antepartum hemorrhage
 (APH), hypertension and edema reported by in-patient departments (IPD) of health
facilities
 Cases of abortion attended at health facilities
 Cases ofmedical (safe) abortions conducted at health facilities

2. intrapartum care
 Deliveries by skilled attendants (at health facilities)
 Deliveries by health extension workers (HEW) (at home of health posts)
 Institutional cases of maternal morbidity and mortality due to labor

3. postpartum care
 1st postnatal care attendance
 Institutional cases of maternal morbidity and mortality due to postpartum hemorrhage
(PPH) and puerperal sepsis
 4. interpartum period
 Family planning method acceptors (new and repeat)
 Family planning methods issued by type of method

These indicators, although not complete to monitor all aspects of maternal survival strategies,
capture data related to pregnancy, such as intrapartum and postpartum care, and are sufficient to
give a broad indication of the performance of the package of maternal survival interventions. More
so, using these indicators help prompt further investigations when problems on issues arise.

Child Mortality and Child Survival Interventions

The leading cause of under-5 child mortality in the Philippines in 2012, as reported by the
Department of Health (DOH) in its top 10 leading causes of child mortality report, was pneumonia
with 2,051 reported cases. Figure 7.1 shows data on other causes of child mortality, such as
diarrhea and gastroenteritis, congenital anomalies, septicemia, other diseases of the nervous
system, accidental drowning and submersion, dengue fever and dengue-hemorrhagic fever,
chronic lower respiratory diseases, meningitis, leukemia.

Figure 7.1 Leading cause of under-five child mortality in the Philippines

The Philippine government through DOH launched various Strategies to help ensure good
health of Filipino children by 2025.

1. Child 21 - Child 21 or the Philippine National Strategic Framework for Plan Development
for Children 2000 to 2025 serves as a framework for policymaking and program planning
and as a roadmap for interventions aimed at safeguarding the welfare of Filipino children.
This is part of the Philippines' commitment to the United Nations Convention on the Rights
of the Child (UN CRC).
2. Children's Health 2025 - This is a subdocument of Child 21 which focuses on the
development of Filipino children and the protection of their rights by utilizing the life cycle
approach.
3. Integrated Management of Childhood Illness (IMCI) - IMCI is a strategy that aims to
lower child mortality caused by common illnesses.
 4. Enhanced Child Growth - This is an intervention aimed to improve the health and
nutrition of Filipino children by operating community-based health and nutrition posts all
throughout the country.

Stop TB Program
Envisioning a tuberculosis-free world, the goal of the Stop TB Program (STP) is to
dramatically reduce the global burden of tuberculosis (TB) by 2015. This is in line with the WHO's
millennium development goals and the Stop TB Partnership which aims to push TB up the world
political agenda. One of the main objectives of the program is to achieve universal access to high-
quality care (i.e., universal access to high quality diagnosis and patient-centered treatment) for all
people with TB (including those co-infected with HIV and those with drug-resistant TB).
TB case detection and successful completion of the treatment/cure of TB remain at the
core of the Stop TB strategy. Thus, by 2050, one of the targets of the strategy is to reduce the
prevalence of and deaths due to TB by 50 percent compared with the 1990 baseline.

The HMIS indicators to monitor Stop TB Program are

 TB patients on DOTS (Number of new smear-positive pulmonary TB cases enrolled in the
cohort)
 TB case detection (Number of new smear-positive pulmonary TB cases detected, number
of new smear-negative pulmonary TB cases detected, number of new extra-pulmonary TB
cases detected)
 HIV-TB co-infection (Proportion of newly diagnosed TB cases tested for HIV)
 HIV+ new TB patients enrolled in DOTS
 TB treatment outcome (Treatment completed PTB+, Cured PTB+, Defaulted PTB+,
Deaths PTB+)

KEY POINTS TO REMEMBER

 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 primary aim of HMIS is to have a strong M&E and review system in place for the
national health strategic plan that comprises all major disease programs and health systems.
 There are different HMIS indicators which can be used in monitoring the key aspects of
the health system performance. These are from among the five broad categories, namely,
reproductive health, immunization, disease prevention and control, resources utilization,
and data quality.
 HMIS is a source of routine data necessary for monitoring different aspects of various
health programs implemented in a country. The HMIS indicators should be carefully
selected to meet the essential information necessary for monitoring the performance of
various health programs and services and to present an overview of the available health
resources.
LESSON 8 HMIS DATA QUALITY
Data Quality
Over the years, data quality has become a major concern for large companies especially in the areas
of customer relationship management (CRM), data integration, and regulation requirements. Aside from
the fact that poor data quality generates costs, it also affects customer satisfaction, company reputation, and
even the strategic decisions of the management.
Data quality is the overall utility of a dataset(s) as a function of its ability to be processed easily
and analyzed for a database, data warehouse, or data analytics system.

Aspects of Data Quality

 Accuracy
 Completeness
 Relevance
 Consistency
 Reliability
 Presentability
 Accessibility

Data quality signifies the data's appropriateness to serve its purpose in a given context. Having quality
data means that the data is useful and consistent. Data cleansing can be done to raise the quality of available
data (Rouse, 2005).

Lot Quality Assurance Sampling (LQAS)

Lot Quality Assurance Sampling (LQAS) is a tool that allows the use of small random samples
to distinguish between different groups of data elements (or lots) with high and low data quality. For health
managers and supervisors, using small samples makes the conduct of surveys more efficient. This tool has
been widely applied in the health care industry for decades and has been primarily used for quality assurance
of products.
The concept and application of LQAS have been adopted in the context of District Health
Information System (DHIS) data quality assurance. The adoption was comprised of designating health
facilities, monthly reports, sections of monthly reports, and group of data elements as 'lots' to provide
representative samples for data quality assurance of DHIS.

Steps in applying LQAS

1. Define the service to be assessed (e.g,. DQA of DHIS).
2. Identify the unit of interest (e.g., a supervisory area, facility, hospital, a district).
3. Define the higher and lower thresholds of performance based on prior information about the
expected performance of the region of interest.
4. Determine the level of acceptable error.
5. Determine the sample size and decision rule for acceptable errors to declare an area as performing
"below expectations."
6. Identify the number of errors observed (mismatched data elements will be reliably determined if
the facility is performing above or below expectations).
Routine Data Quality Assessment (RDQA)
The Routine Data Quality Assessment (RDQA) tool is a simplified version of the Data Quality
Audit (DQA) tool which allows programs and projects to verify and assess the quality of their reported
data. It also aims to strengthen data management and reporting systems.

The objectives of RDQA are as follows (RDQA User Manual, 2015):

1. Rapidly verify the quality of reported data for key indicators at selected sites.
2. Implement corrective measures with action plans for strengthening data management and reporting
system and improving data quality.
3. Monitor capacity improvements and performance of data management and reporting system to
produce quality data.

The RDQA is a multipurpose tool that is most effective when routinely used. Following are the uses for
the RDQA tool (RDQA User Manual, 2015):
RDQA Use Case Example
Routine data quality Routine data quality checks can be included in already planned
checks as part of on- supervision visits at the service delivery sites.
going supervision
Initial and follow-up Repeated assessments (e.g., biannually or annually) of a system's
assessments of data ability to collect and report quality data at all levels can be used to
management and identify gaps and monitor necessary improvements.
reporting systems
Strengthening of the Monitoring and evaluation (M&E) staff can be trained on the RDQA
program staff's capacity and sensitized to the need to strengthen the key functional areas linked
in data management and to data management and reporting in order to produce quality data.
reporting
Preparation for a The RDQA tool can help identify data quality issues and areas of
formal data quality weakness in the data management and reporting system that would
audit need to be strengthened to increase readiness for a formal data quality
audit.
External assessment by Such use of the RDQA for external assessments could be more
partners of the quality frequent, more streamlined, and less resource intensive than
of data comprehensive data quality audits that use the DQA version for
auditing.

Development Implementation Plan

An implementation plan is a project management tool that illustrates how a project is expected to
progress at a high level. It helps ensure that a development team is working to deliver and complete tasks
on time (Visual Paradigm, 2009). It is also important in ensuring the efficient flow of communication
between those who are involved in the project so as to minimize issues that would delay delivery of the
project. It validates the estimation and schedule of the project plan.

An implementation plan is developed through the following key steps (Smartsheet, 2017):
 Define goals/objectives. Address the question, "What do you want to accomplish?"
 Schedule milestones. Outline the deadline and timelines in the implementation phase.
  Allocate resources. Determine whether you have sufficient resources, and decide how you will
procure those missing.
 Designate team member responsibilities. Create a general team plan with overall roles that each
team member will play.
 Define metrics for success. How will you determine if you have achieved your goal?

Data Quality Tools

A data quality tool analyzes information and identifies incomplete or incorrect data. Data
cleansing follows after the complete profiling of data concerns, which could range anywhere from removing
abnormalities to merging repeated information.
By maintaining data integrity, the process enhances the reliability of the information being used
by an organization. Usually, these data quality software products can share features with master data
management, data integration, or big data solutions.

Gartner (2017) explains how these data quality tools are used to address problems in data quality:
 Parsing and standardization refers to the decomposition of fields into component parts and
formatting the values into consistent layouts based on industry standards and patterns and user-
defined business rules.
 Generalized "cleansing" is the modification of data values to meet domain restrictions,
constraints on integrity, or other rules that define data quality as sufficient for the organization.
 Matching is the identification and merging of related entries within or across data sets.
 Profiling refers to the analysis of data to capture statistics or metadata to determine the quality of
the data and identify data quality issues.
 Monitoring refers to the deployment of controls to ensure conformity of data to business rules set
by the organization.
 Enrichment is the enhancement of the value of the data by using related attributes from external
sources such as consumer demographic attributes or geographic descriptors.

As data quality continues to become increasingly all-encompassing, data integration tools are further
developed to include data quality management functionality.

Application/Scope of Data Quality Tools

The first generation of data quality tools was characterized by dedicated data cleansing tools
designed to address normalization and reduplication. However, in the last 10 years, it was observed that
there is a generalization of Extract, Transform, Load (ETL) tools which allow the optimization of the
alimentation process. Recently, these tools started to focus on Data Quality Management (DQM), which
generally integrates profiling, parsing, standardization, cleansing, and matching processes (Goasdue,
Nugier, Duquennoy, and Laboisse, 2007).

Root Cause Analysis

A root cause analysis is a problem solving method that identifies the root causes of problems or
events instead of simply addressing the obvious symptoms. The aim is to improve the quality of products
and services by using systematic ways to address problems in order to be effective (Bowen, 2011).

Techniques in Root Cause Analysis

Root cause analysis is among the core building blocks in the continuous improvement efforts of
an organization in terms of its operation dynamics, especially in the way it handles information. However,
root cause analysis alone will not produce any valuable results. The organization should seek to improve at
every level and in every department for this to work. The analysis will help develop protocols and strategies
to address underlying issues and reduce future errors. Bowen (2011) suggests that "to address the root cause
of a problem, one must identify the problem and ask "why" five times to determine the proper strategies to
address its root cause."

1. Failure Mode and Effects Analysis

The failure mode and effects analysis (FMEA) aims to find various modes of failure within a system and
addresses the following questions for execution:
a. What is the mode in which an observed failure occurs?
b. How many times does a cause of failure occur?
c. What actions are implemented to prevent this cause from occurring again?
d. Are these actions effective and efficient?

FMEA is used when there is a new product or process or when there are changes or updates in a product
and when a problem is reported through customer feedback.

2. Pareto Analysis

Figure 8.1 Pareto Chart Showing Causes of Malnutrition

The Pareto analysis uses the Pareto principle which states that 20 percent of the work
creates 80 percent of the results. It is used when there are multiple potential causes to a problem. The Pareto
chart was created using the Excel software. It lays down the potential causes in a bar graph and tracks the
collective percentage in a line graph to the top of the table. The reflected causes from the table should
account for at least eighty percent of those involved in the analysis.

3. Fault Tree Analysis

The fault tree analysis (FTA) is used in risk and safety analysis. It uses boolean logic to determine the
root causes of an undesirable event. The undesirable result is listed at the top of the tree and then all the
potential causes are listed down to form the shape of an upside down tree.
 4. Current Reality Tree

Figure 8.2 Current Reality Tree Chart Showing Overcrowded Bus

The current reality tree (CRT) is used when the root causes of multiple problems need to be analyzed all at
once. The problems are listed down followed by the potential cause for a problem. By doing so, a cause
common to all problems will appear.

5. Fishbone Diagram

Figure 8.3 Fishbone Diagram Showing Patient Dissatisfaction with Health Care Services

The fishbone diagram is also called the Ishikawa or cause-and-effect diagram. The diagram looks like a
fishbone as it shows the categorized causes and sub-causes of a problem. This diagramming technique is
useful in grouping causes (e.g., people, measurements, methods, materials, environment, machines) into
categories. Categories could be the 4 Ms (manufacturing), the 4 Ss (service), or the 8 Ps (also service)
depending on the industry.
 6. Kepner-Tregoe Technique
The Kepner-Tregoe technique breaks a problem down to its root cause by assessing a situation using
priorities and orders of concern for specific issues. The various decisions that should be made to address
the problem are then outlined. Then, a potential problem analysis is made to ensure that the actions
recommended are sustainable.

7. Rapid Problem Resolution (RPR Problem Diagnosis)

Another technique for root cause analysis is the rapid problem resolution (RPR problem diagnosis) which
diagnoses the causes of recurrent problems by following the three phases below:

 Discover — data gathering and analysis of the findings

 Investigate — creation of a diagnostic plan and identification of the root cause through careful
analysis of the diagnostic data
 Fix - fixing the problem and monitoring to confirm and validate that the correct root cause was
identified

Sustaining a Culture of Information Use

Choo, Bergeron, Detlor, and Heaton (2008) state that information culture affects outcomes of information
use. The information culture is determined by the following variables: mission, history, leadership,
employee traits, industry, and national culture. It can also be shaped by cognitive and epistemic expectations
which are influenced by the way tasks are performed and decisions are made.

The result suggests that in order to have a sense of information attitudes and values, managers should
consider taking the pulse of information of their own organizations. The sets of identified behaviors and
values could account for significant proportions of the variance in information use. Thus, management
plays an important role in sustaining a culture of information and should continuously work on maintaining
and improving the quality of data and information used in daily operations.

KEY POINTS TO REMEMBER

 Data quality is the overall utility of a dataset(s) as a function of its ability to be processed easily
and analyzed for a database, data warehouse, or data analytics system.
 Lot Quality Assessment (LQAS) is a tool that allows the use of small random samples to distinguish
between different groups of data elements (or lots) with high and low data quality.
 The Routine Data Quality Assessment (RDQA) tool is a simplified version of the Data Quality
Audit
(DQA) which allows programs and projects to verify and assess the quality of their reported dat
 The development of an implementation plan is important in ensuring that the communication
between those who are involved in the project will not encounter any issues and work will also be
delivered on time.
 A root cause analysis is a problem solving method aimed at identifying the root causes of problems
or events instead of simply addressing the obvious symptoms.
 Techniques in root cause analysis include failure mode and effects analysis (FMEA), Pareto
analysis, fault tree analysis (FTA), current reality tree (CRT), fishbone or Ishikawa or cause-and-
effect diagram, Kepner-Tregoe technique, and RPR problem diagnosis.
 LESSON 9: HOSPITAL INFORMATION SYSTEM
Hospital Information System
Health care plays a vital role in a society and people expect efficiency from health care Providers
and health institutions which face the challenge of handling the numerous patients that seek their
services. Proper management of clinical and operational records is therefore necessary. Presently,
most hospitals have shifted from tedious manual recording to the use of a hospital information
system (HIS) to assist them in maintaining the different records of the institution.
Hospital information system (HIS) is a computer system structured to manage all the records of
health care providers to make available information and reports useful to health care personnel in
do their job more efficiently. HIS was introduced in the 1960s and has evolved since then to cope
with the changes and demands of the modern times. Back then, the features of HIS were used
mainly for billing and inventory. However, all of these have changed through time. Today's system
is also integrated with other financial, scientific, and administrative programs.
The modern HIS has applications built to address the needs of the various departments of health
facilities such as nursing, pharmacy, finance, radiology, and pathology. There are hospitals with
as many as 200 disparate systems integrated into their HIS. Hospitals using the HIS experience
efficiency in accessing reliable patient information with just a few clicks. However, advancements
and new developments will be rendered useless if the system is not user-friendly and training is
inadequate.
While HIS delivers high quality patient care and better management of financial records, it needs
to be affordable, scalable, and centered on the needs of patients and medical personnel. It should
be adaptable to rapid technological changes. An effective HIS also provides enhanced integrity of
facts, minimization of transcription error and duplication of records, and shorter turnaround times
for reports.
HIS available today links computers that are capable of quickly optimizing operations and
delivering quality service. The systems gather, process, retrieve patient information, and provide
hospital stakeholders with relevant information through reports for better decision-making.
The system also guarantees delivery of information required by the health care personnel because
Of the optimized core library. It can also be customized to consider the particular needs of the
departments and centralize them into the system. However, a hospital should provide the
requirements in detail to the HIS provider during the initial stages of scoping so that its needs will
be met and accurately provided. For example, the institution could ask that the solution be based
on RDBMS (relational database management system) or ask for a multilingual interface for better
handling of information (EMR Education Center, 2013).

HIS for Different Departments

1. Nursing Information Systems
 Nursing information systems (NIS) are developed to enhance patient care by providing nurses
with accurate information to assist them in performing their duties more efficiently. An NIS carries
out numerous functions including the handling of personnel schedules, accurate patient charting'
and better clinical integration.
Agenda packages help enhance the management of the workforce by helping managers handle
overtimes and absences. They can also be used to obtain cost-effective staffing and show staffing
levels patient charting applications allow better analysis of critical signs. Nurses could check
admission, information, and care plans along with applicable nursing notes. Crucial information is
kept and can be retrieved when needed. This is also useful in designing the patients' care plan since
the medical information integration function allows nurses to collect and examine retrieved
medical records.
2. Physician Information Systems
Physician information systems (PIS) are designed to improve the practice of physicians. Electronic
medical records (EMRs) and electronic health records (EHRs) are some programs where PIS is
deployed and extensively used. Most systems offer support 24/7 to facilitate easier usage of the
system by health care professionals.
3. Radiology Information Systems
Radiology information systems (RIS) are capable of providing billing services and appointment
scheduling aside from reporting and database storage. Technological advances have made the
practice of radiology more complicated such that more and more hospitals turn to RIS to address
the commercial concerns of their radiology departments.
4. Pharmacy Information Systems
Pharmacy information systems (PIS) help monitor the utilization of medicines in health
institutions. The system also handles information on medication-related complications and drug
allergies of patients. It provides information to identify drug interactions which helps in
administering the appropriate drugs by considering the physiological conditions of the patient
(EMR Education Center, 2013).

Selecting a Hospital Information System

The following are the aspects needed to be considered in selecting an HIS (EMR Education
Center, 2013):

I. Total cost of package — HIS is available for all sizes and budgets. For hospitals with smaller
budgets, providers may reduce upfront and maintenance fees by using a design that requires fewer
servers and hardwares.
2. Web-based system — The system is available on the internet which means that authorized
personnel can access the information anywhere and anytime. It also allows data sharing between
hospitals. A hospital with updated patient history in its system can facilitate access to information
from other health facilities upon request.
3. Implementation and support — During the deployment or upgrade of the HIS, it is imperative
that the vendor provides ample training and assistance to the users of the system. Consider vendors
that offer 24/7 support through telephone or web services.

HIS Providers in the Philippines

BizBox
BizBox, Inc. was founded 25 years ago. Its very first hospital project was completed in 1994. The
of the company is to improve work efficiency in health care institutions through software systems,
and to
Today, it is among the top IT companies in the health care industry. Aside from being a certified
Microsoft Gold Partner, it has also received the Independent Software Vendor (ISV) of the Year
Award. It has fully integrated systems such as electronic health records (EHR) and document
management system (DMS) that will streamline tasks and help provide better health services
(BizBox, 2017).

KCCI Medsys
Kaiser-dela Cruz Consulting, Inc. specializes in application development for hospitals, industrial
clinics, and medical-related educational institutions in the Philippines. Its products, Visual
MEDSYS for hospitals and MEDSCHO for schools, provide integrated, comprehensive, and
proven solutions for efficient health care practices.

Comlogik
Comlogik Business Systems, Inc. is a Philippine-based software development company that was
established in 1999, with a vision to be a global technology company. Comlogik led the way in
developing innovative applications like online hospital services in which patients can access their
billings and examination results, while administrators can access reports and doctors can access
patients' records anywhere and anytime.
HIS Functions
Help Desk, Scheduling, Patient Registration
Help desk
The help desk becomes more efficient through the HIS because the manual retrieval of
information is no longer needed. Clients are provided with information and guidelines associated
with a company's or institution's products and services without any hassle.
Scheduling
Managers and employees can access work schedules from anywhere they are and effectively
discuss their scheduling preferences through the HIS. An employee scheduling software helps save
time and makes employee scheduling less difficult.
Patient Registration
The HIS patient registration form records the name, age, gender, marital status, and other relevant
information regarding the patient. These pieces of information are used for record keeping and
account management purposes. This form is usually filled out during the patient's visit or
consultation but if the patient is unable to complete the form due to the need for prompt medical
attention, the form can be filled out by a relative or guardian.
Admission, Discharge, and Transfer Procedures
Admission
Before a patient is admitted to a health facility, an admissions counselor will call him or her to
gather preliminary information, offer vital information concerning the hospital stay, and answer
questions if there are any. Additionally, the physician may also schedule recurring medical exams,
such as laboratory tests or X-rays, before hospitalization. Other routine tests can also be carried
out on the day of admission. All these can be done more efficiently through the HIS.

Discharge
Through the HIS, instructions that accompany a patient's discharge or transfer are more efficiently
provided. These instructions may include discharge planning which details services needed to be
administered after the hospital stay to ensure the full recovery of the patient.
Transfer
The term "transfer" means movement (along with the discharge) of an individual outside of the
hospital premises at the instruction of any authorized hospital personnel. This, however, does not
encompass movement of an individual who (a) has been declared lifeless, or (b) leaves the facility
without the permission of any such authorized person (Louisiana State University, 1993).
If a patient is transferred from the emergency room, employees must fulfill the statutory
requirements for a proper switch. With the HIS, patient transfer details are easily accessed and
processed.
Billing, Contract Management, and Package Deal Designer
Billing
Billing statements show all records pertaining to the invoices, payments, and the current balance
of a patient's account. HIS is very useful for patients who require frequent health care services
because numerous invoices can be combined and a lump sum payment can be made. It is good
practice to generate the billing statement on a regular basis so that the institution could keep track
of its collectibles. HIS lists the outstanding balances of the patients. Any overdue payments may
be checked easily. In addition, balances of patients who only have minimal transactions are kept
updated.
Contract Management
Goodrich (2013) defines contract management as the process of managing contract creation,
execution, and analysis to maximize the operational and financial performance of an organization
while reducing financial risk. Organizations constantly encounter pressure to reduce costs and
improve company performance. Contract management proves to be a very time-consuming
element of business, which facilitates the need for an effective and automated contract
management system.
When a contract management strategy is successfully implemented, organizations can expect to
see the following:
 realization of expected business benefits and financial returns
 cooperation and responsiveness of the supplier to the organization's needs
 no contract disputes or surprises satisfactory delivery of services to both parties
Package Deal Designer
Posting diagnostic medical packages for in-patients, out-patients, and emergencies requires the
same process; the difference is that for emergencies, this is called post-diagnostic package deal.
HIS helps in accessing information regarding package deals without going through the hassle of
paperwork.
Laboratory, Radiology, and Cardiology Reporting
Laboratory Reporting
Despite differences in presentation and form, all laboratory reports must possess common
elements as required by institutional and company policies. They may also contain supplementary
items not specifically required, but which the laboratory chooses to report to aid in the
interpretation of results of medical testing (American Association for Clinical Chemistry, 2017).
For identification and filing purposes, some laboratory reports display elements with
administrative or clerical information such as the following:
 Patient name and identification number or a unique patient identifier and identification
number
 Name and address of the laboratory location where the test was performed
 Date when report was printed
 Test report date
 Name of doctor or legally authorized person ordering the test(s)
Information about the specimen and the test itself, such as those included below, are other
elements that make a laboratory report more meaningful:
 Specimen source (if applicable) Date and time of specimen collection
 Laboratory accession number
 Name of the test performed
 Test results
 Abnormal test results
 Critical results
 Units of measurement (for quantitative results)
 Reference intervals (or reference ranges)
 Interpretation of results
 Condition of specimen
 Deviations from test preparation procedures
 Medications, health supplements, etc. taken by the patient

Radiology Reporting
According to the University of Virginia (2013), a radiology report is an official medical document
that provides the details of the requested radiology examination and the procedure conducted by
the radiologist A qualified physician authorized by the health care institution interprets the report.
The main objective of the report is to address the queries in the request. The findings in the report
should take into account both positive and negative findings. Important findings should be stated
followed by incidental findings.
The basic sections of a radiology report enumerated in the American College of Radiology's
Practice guideline on communication must include administrative information, patient
identification, clinical history, imaging technique, comparison, observations, summary or
impression, and signature of the radiologist. The length of the report is dependent on the
complexity and cost of the examination.

Cardiology Reporting
Cardiology reports, like other laboratory reports, contain important medical information based on
the test results of the patient which are set against past medical records. Doctors are able to write
vascular reports much faster since access and retrieval of information are made more convenient
through computer systems.
Using the cardiology information systems (CIS), vascular sonography reports are accurately
created with only a few clicks. Information on these reports could include ultrasonic ultrasound
and diagrams. Nowadays, physicians opt to provide automated reports through the use of
information systems. The medical staff can process laboratory reports for the approval of the
physician. This means that results are generated more efficiently which translates to improved
patient experience.

Materials Management System—Pharmacy, Main Stores, and

Purchase

Materials management is primarily concerned with planning, identifying, purchasing,

storing,receiving, and distributing materials. Its purpose is to guarantee that the right and sufficient
materials are in the right location when needed.
As such, the automation of an inventory or a materials management system is necessary for a
hectic health center to streamline the hospital supply chain. Computerized stock management
systems include technologies for tracking inventories and devices used each day in a health care
setting. Generally, they utilize barcodes and RFID tags with precise identification numbers
assigned for each inventory Object to enable accurate tracking and control. Automatic stock
management .systems also assist health care institutions in figuring out whether merchandise has
been recalled or damaged and should not be given to patients. They enable isolation of drugs and
devices that are used regularly and forecasts capacity shortages (Pontius, 2018).
Virtually, every health care institution has a materials management department that is accountable
for receiving materials, retaining central stock, and delivering supplies within the institution.
Typically this is where the responsibility of the materials management department ends. An
inspection of a nursing unit' suite, or exam floor will reveal •a smaller, self-managed inventory in
supply closets, nurses' stations' and individual rooms. These inventories are essential in
maintaining supplies conveniently available for use.

Management Reporting
Today, management reporting is not limited to data retrieval. It has become a platform for
reporting and controlling information valuable to the institution. Recent technological
advancements help management reports to provide non-monetary information which enables the
management to have an oversight of its operations. In the same way, these advancements pave the
way for the emergence of management reporting systems. These systems capture the necessary
data required by management to operate more efficiently. With this, data redundancy and data
quality issues are minimized. Employee headcount, customer account information, funding, and
overall performance are some of the data that can be retrieved through the system. Thus, a good
management reporting system enhances the capability of an institution to be more responsive,
efficient, and effective in decision-making which affects the performance of the institution as a
whole. These systems offer a single holistic view which highlights high value sources and
eradicates the lack of visibility in reviewing the performance of the institution (Kumar, 2017).

In-Built Tally Interface

Tally.ERP9 is a software that provides simplified solutions to operations in health institutions
such as registration, accounting, inventory management, tax management, among others. Tally is
easy to learn and can be implemented with minimum resources. It is reportedly used by over
1,000,000 entities across the globe.
KEY POINTS TO REMEMBER
 A hospital information (HIS) is a fundamental computer system that
could manage all the information to permit health care providers to
do their job efficiently.
 HIS for different departments are nursing information systems (NIS)
physician information systems (PIS), radiology information system
(RIS), and pharmacy information system (PIS).
 The following should be considered during the selection of the HIS:
total cost of the package, web-based system, and implementation
and support.
 The top 3 HIS providers in the Philippines are Bizbox, Inc., KCCI
Medsys, and Comlogik.
 The functions of HIS address the following concerns: help desk,
scheduling, patient registration, admissions, discharge and transfer
procedures, billing, contract management, and package deals.
 Materials management is primarily concerned with the planning,
identifying, purchasing, storing, receiving and distribution of
materials. Its purpose is to guarantee that the right and sufficient
materials are in the right location when needed.
 Management reporting systems help in capturing the data sets that
are needed for managers to run an effective enterprise.
 LESSON 10: LABORATORY INFORMATION MANAGEMENT
SYSTEMS
Laboratory Information Management System
The laboratory information management system (LIMS) is designed to help process information in medical
research to improve the efficiency of the department's services and laboratory operations by reducing
manual tasks and procedures. For example, a LIMS records information automatically which saves time
and reduces typographical error. This is commonly used in conjunction with laboratory information systems
(LIS) in the medical and pharmaceutical industries.
According to Gartner's 2016 Hype Cycle for Life Sciences, most of the top pharmaceutical use LIMS. The
system is also useful for biobanks and genomic testing centers and laboratories that study drugs and develop
formulations. However, the health care institution must consider the data capture process, storage, and
retrieval in selecting the solutions provider because some are more suitable than others (Reisenwitz, 2017).

Functional Requirements and Features of LIMS

According to Reisenwitz (2017), the functionality of LIMS includes sample management, workflow
management, reporting, electronic medical records (EMR)/electronic health records (EHR), mobile and
enterprise resource planning (ERP).

Sample Management
Accurate and detailed records are necessary to make sure that samples are not lost or mixed up. A record
should show whether the sample meets the acceptable values.
LIMS records and stores the following information about the sample:
 Who the sample was taken from?
 What is the sample taken?
 Who is working with it (researcher or provider)?
 Who handled the sample?
 Where does it go next?
 How do you store these samples? When does it need to move?
LIMS automates most of these by using radio-frequency identification (RFID) or barcodes in recording
and updating logs and track the chain of custody of the sample.

Workflow Management
Workflow Management can be used to automate records and workflows which saves time. Existing coding
methods and enable the system to take part in the decision process. Using preset rules, it can suggest
instruments the procedure and assign the medical laboratory technician or specialist to complete the test

Reporting
Using LIMS, reports can be run and exported to make them standard and customized. Reports on the
frequently used instrument, the average handling time of sample, and list of backlogs are useful in data
analysis and formulation of recommendation for future policymaking.

EHR
 Some LIMS have a built-in electronic health records (EHR) functionality which is capable of handling
patient records and billing information. A health institution should consider this during acquisition because
this feature will greatly help in managing clinical laboratory procedures.

Mobile
Gartner'S (2016) reports that mobile LIMS offerings are limited. But with the accepted use of smartphones
in the laboratory, it is better for LIMS to be mobile-friendly.

ERP
A LIMS that can handle inventory functions is recommended. The enterprise resource planning (ERP)
solution is especially useful in viewing current supplies, calculating storage capacity, and managing
location.

Core Components of LIMS

LIMS software suites usually involve multiple components to provide a variety of functions for different
levels of the laboratory. IEEE GlobalSpec (2015) specifies the components of a LIMS software but are not
limited to the following:

 Electronic laboratory notebooks

 Sample management programs
 Process execution software
 Records management software
 Applications to interface with analytical instruments or data systems
 Workflow tools
 Client tracking applications
 Best practice and compliance databases
 ERP software

Laboratory Standards
To help promote laboratory safety, the Occupational Exposure to Hazardous Chemicals in Laboratories
Standard (29 CFR 1910.1450) was released in the United States by the Occupational Safety and Health
Administration (OSHA) in 2011.
Some important provisions from the standard are cited below:
Laboratory is a workplace where hazardous chemicals are used. It is also a facility that
stores small quantities of hazardous chemicals which are not intended for production use. On the other
hand, the laboratory use of hazardous chemicals should meet the conditions listed below:

 The manipulations of chemicals should be on "laboratory scale" only and can be handled by one
person.
 There is the use of multiple chemicals and procedures.
 The procedures should not simulate any production process.
 Protective laboratory tools are available and proper practices are followed to minimize potential
exposure to harmful chemicals.
  Any hazardous use of chemicals which does not meet this definition is regulated under other
standards. Examples are
 chemicals used in the maintenance of the laboratory building,
 production for commercial sale, and
 testing of a product for quality control.
A Chemical Hygiene Plan (CHP) which discusses al! aspects of the laboratory standards should be
formulated if the standards apply. The employer must implement the provisions which address the proper
purchase, storage, handling, and disposal of the chemicals used in the facility.
The primary elements of a CHP include the following:
1. establishment of standard operating procedures (SOP) to minimize exposure to chemicals and
dissemination of information on the requirements for personal protective equipment, waste
disposal procedures, and engineering controls;
2. monitoring of the work environment to provide the action and medical attention required for
some chemicals;
3. statement of plan on how to obtain free medical care for work-related exposures; and
4. designation of personnel who will handle CHP-related activities such as handling data sheets,
organizing trainings, monitoring adaption, and revising CHP if deemed necessary

LIMS Application
Patient Registration
When a patient arrives at the hospital, the admission clerk will take some basic information and will guide
him or her to a registration window.
Billing
The process of generating SOAs (statement of accounts) or billing statements of patients, and emergencies
are the same. In the following example, an in-patient's billing Statement is out.

Contract Management
Most LIMS allow the laboratory professionals to manage the billing and payment aspects of their activities
and to create statistical and billing reports on a par with the laboratory and management needs. They provide
parameters for a flexible price schedule and enable heightened attention on customer They automate billing
processing, hasten collections, and offer marketing tools which reduce the time spent on standard flow and
allow billing and accounting personnel to focus on improving collection of problematic accounts (Infomed,
2017).
In addition, the common features of LIMS for invoicing and contract management include:

 customer customizable invoices including history analysis of balance and charges, history balance,
detailed services, and participation when in insurance coverage, discounts, among others;
 different electronic formats for invoices to allow interfacing with customer electronic systems;
 customizable information completion reports for customers;
 managerial reports which display laboratory billing status for payer groups including projected
return values for each payer group; ability to change the insurance organization of a patient per
visit;
 ability to select which tests are covered by insurance and which have automatic modification of the
prices accordingly;
 supervision of financial data management of the senders;
 reminder for amounts due from past visits;
  immediate access to the billing card of each patient; and
 consistency with international laws.

Accounts Receivables
Through the integration of the LIMS, the personnel in charge of managing accounts receivables
can easily extract information which was already available from the invoicing and contract management
procedures. Additionally, the LIMS

 can generate specific or complete accounts receivable reports,

 monitor balances for reconciliation and audit purposes,
 export data to other accounting systems, and
 customize reports according to specifications.

Worklist and Workflow

LIMS assists laboratories in setting priorities of current workloads based on analyst and instrument
availability. This function allows the user to track a sample, a batch of samples, or numerous batches
through their lifecycle. Queuing can also be done by sample or by workflow which is a block of repetitive
procedures in a certain process. The queuing and work list feature provides insights about when an event
occurred, how long it was, and who was involved.
In addition, other features also enable personnel and workload management, thereby, allowing
users to plan workload schedules and assignments, and employee information and training. Ultimately, the
worklist and workflow functions operate to facilitate more efficient laboratory processes.

Quality Control
Diagnostic tests executed inside the clinical laboratory may yield two kinds of results, a patient
result or a quality control (QC) result. The result can be quantitative (in numbers), or qualitative (positive
or negative) or semi-quantitative (limited to a few different values). QC results are used to verify whether
or not the instrument is working within prescribed parameters. Based on the said results, reliability of a
patient's test results will be determined (Bio-Rad Laboratories, 2008).
LIMS' functions enable users to set standards about the relevant range of patient test results or to
extract test result information for the purpose of quality assurance. Outliers and deviations can be flagged
and appropriate warning signals can notify users about issues which might involve the quality of the
samples or the equipment currently in use.

Barcode-generation, Printing, and Reading

LIMs modules are commonly linked to a barcoding label generator which enables a fast and method to
identify tubes, samples, documents, and many others. The code can simply be printed on a label sticker to
be placed on any item which needs identification. A barcode editor also allows multiple labels to be printed
at a label printer. The barcode series can usually be customized to suit the Organization's or classification
needs. With this kind of technology, information about a tube, a specimen, Or equipment within the
laboratory can be found and retrieved effortlessly using a barcode scanner.
In-built Bi-directional Interfaces with Equipment
Figure 10.4 shows the interface of a bi-directional equipment used in medical laboratories. A two-way
communication between the information system and the clinical instrument is required. LIMS downloads
the test orders and specimen ID for each test. On the other hand, the clinical instrument uploads the same
information for analysis. The same method is also used by instruments for microbiology, hematology, and
other areas.
When a health institution uses this type of application, productivity is enhanced because it minimizes the
time spent in programming the order into the analyzer, and ensures accuracy due to the elimination of errors
usually committed in the manual process. Nowadays, these machines also have the random access testing
feature and barcode label scanning for specimen (Selmyer &amp; Cloutier, 1996).

KEY POINTS TO REMEMBER

 A laboratory information management system (LIMS) is a software designed
to make laboratories more efficient and effective.
 The ultimate aim of a LIMS is to enhance efficiency in laboratory operations
by reducing manual procedures.
 The core components of LIMS are electronic laboratory notebooks, sample
management programs, execution software, records management software,
applications interface, work flow tools, client tracking, best practice and
compliance databases, and ERP software.
 The US Occupational Safety and Health Administration (OSHA) released an
Occupational Exposure to Hazardous Chemicals in Laboratories Standard (29
CFR 1910.1450) in 2011 to facilitate laboratory safety.
 LIMS covers registration, billing, contract management, and monitoring of
accounts receivable.
 LIMS assists laboratories in setting priorities of current workloads based on
availability of analysts and instruments.
 LIMS' functions enable users to set standards for the relevant range of patient
test results or to extract test result information for the purpose of quality
assurance.
 LIMS modules are commonly linked to a barcoding label generator, enabling
a fast and easy method of identifying tubes, samples, documents, and many
others. The label can simply be printed on a sticker and be placed on any item
which needs identification.
 A bi-directional interface application saves time in programming test orders
into the analyzer and eliminates errors in manual entry. This can result in a
considerable enhancement of analyzer productivity.
LESSON 11

Cardiology Information System

Definition
The cardiology information system (CIS) is mainly focused on the storage and
retrieval cardiology-centric images. This system usually receives an order with patient
demographics from other information management systems. Once the images are
acquired from imaging modalities, they are profiled based on the order and stored for
further distribution, viewing, and long-term archiving (Katipula & Ireland, 2013).

The information used by cardiologists for the diagnosis and treatment of illnesses
varies from personal notes (history, physical examination) to signals
(electrocardiograms), images (echocardiograms angiograms, CT, MRI), and reports from
investigations and procedures. All these types of information can currently be provided in
digital format, and the system serves as repository of these forms of images.
Unfortunately, most systems are limited by their storage capabilities and do not include
post-processing functions.

Evolution of CIS
Decades ago, the requirements for an electronic medical information system were
restricted by the availability of equipment. A good database schema combined with a
functional user interface was deemed adequate. In the 1970s, available cardiology
information systems originated from mainframe environments, whose technical specifics
would be considered ridiculous in today's context.

In the 1980s, modular systems that emphasized the use of real-time applications
and mini computers became the trend (Turney & Kohls, 1997). Over the years, the trend
for smaller computers remained, but the introduction of the internet became a turning
point that shifted the focus of most systems towards creating networks and facilitating
integration. Cardiology information systems nowadays have unique features that enable
remote access and easy retrieval. Some systems have also attempted to integrate
radiology information systems (RIS) to involve more administrative processes and go
beyond storage purposes.

Benefits of CIS
Different CIS, coming from different sellers, vary in their available features. However, the
following are the most common benefits:

1. Ease of Access while Maintaining Data Security

CIS consolidates multiple types of patient cardiology information, thus eliminating
the need for doctors to request different imaging results from different departments.
 2. Flexibility in the Workflow
Availability of mobile technology allows cardiologists to assess a wide array of
information without having to leave the patient's bedside. Having cardiological data in a
single platform offers mobility to physicians and nurses, thereby improving the efficiency
of providing service.

3. Enhanced Comparability
CIS is an essential repository of cardiology imagery results; thereby, retrieval of
past data is convenient. This comparability enables health care professionals to make
more informed decisions

Functionalities of CIS
1. Editing, Viewing, and Storing Multi-Modal Cardiology Data - With the help of CIS,
different types of data, including those of computed tomography (CT), cardiac
ultrasound (echocardiography), magnetic resonance imaging (MRI), nuclear imaging
(PET and SPECT), and angiography may be managed on a single platform.
2. Remote Access - The use of networks and integrated information systems, coupled
with the availability of the internet and tablets and smart phones, offers flexibility to
CIS.
3. Visualization and Reporting Capabilities - Two of the main benefits of CIS are the
ease and the consistency of reporting. As a result, virtual real-time information
retrieval is possible anytime and anywhere with just a couple of clicks.
4. EHR Integration — CIS may be integrated with existing electronic health record
systems; this results in the enhancement of the quality of services of the health
professionals by offering a more comprehensive view of the patient care spectrum.

Radiology Information System

A radiology information system refers to a network system used in managing
imagery and associated data in the radiology department. The system tracks the orders
and billing information of the requesting department. It uses picture archiving and
communication systems (PACS) for the storage and management of medical images and
vendor neutral archivals (VNA) to manage image archives and for record-keeping and
billing within a hospital information system (HIS) (Rouse, 2017).

The use of RIS in health care institutions has many advantages in the context of
improving overall operations of the institution. The system enables easier access to
patient information because it can be integrated in referring to the doctor's electronic
health record (EHR) system, resulting in better patient experience. It also allows faster
processing of payments because the insurance plans of patients may be verified prior to
their visit and electronic payment is an available option. It also permits reports to be easily
generated and sent to the requesting department which dramatically improves the
efficiency of the workflow of the institution.
Functions of RIS

Rouse (2017) describes the following functions of an RIS:

• Patient Management — The system tracks the patient's entire workflow within the
radiology department. It can add images and generate reports to EHRs for easy
retrieval and viewing by the authorized radiology staff.
• Scheduling — The system allows staff to schedule appointments for in-patients
and out-patients.
• Patient Tracking — Patient tracking means tracing the patient's radiology history
starting from admission to discharge and coordinating it with his or her past,
present, and future appointments.
• Results reporting — Results reporting is possible through the statistical reports
generated by RIS. The reports may be done for a single patient or a group of
patients, as well as for specific procedures, depending on the needs.
• Image tracking — RIS was traditionally used to track individual films and
associated data. Nowadays, RIS-PACS systems managed by radiology
departments cover the entire clinical workflow of the medical enterprise.
• Billing — Billing is made convenient through the system's financial record keeping
and processing of electronic payments and automated claims.

KEY POINTS TO REMEMBER

✓ Cardiology information system (CIS) is mainly focused on the storage and retrieval
of cardiology-centric images.
✓ The benefits and features of CIS include ease of access while maintaining data
security, flexibility in the workflow, and enhanced comparability.
✓ The functionalities of CIS are editing, viewing, and storing multi-modal cardiology
data; remote access; visualization and reporting capabilities; and EHR integration.
✓ A radiology information system (RIS) is a network software system designed to
manage medical imagery and associated data. An RIS is especially useful for
tracking radiology imaging orders and billing information, and is often used in
conjunction with picture archiving and communication systems (PACS) and vendor
neutral archivals (VNA) to manage image archives and for record-keeping and
billing within a hospital information system (HIS).
✓ The functions of an RIS are patient management, scheduling, patient tracking,
results reporting, image tracking, and billing.
LESSON 12
Materials Management System
The management function of hospital materials—that is, to ensure that services are rendered
successfully from one source to an end user—covers several areas of the hospital and could drastically
affect the expenses of the medical institution. Executing this function in a manner that lessens expenses
and ensures adequate cash flow requires effective management of a large amount of information from
several sources.
To successfully manage such information, many hospitals implement a form of materials
management information system (MMIS). The aforementioned system can be used to manage functions
like purchasing, accounting, inventory management, and patient supply charges ("Materials management
information systems," 1996).

Purchasing

In HIS by BizBox, a purchase request marks the beginning of the procurement process. Using this
form, the user notifies the purchasing Department regarding the needed items and services. It contains
the quantity, as well as a timeframe for the items requested. It has the authorization information needed
to proceed with the purchase. The requested items are then confirmed using the purchase order and a
supplier is nominated. Once completed, the order is sent to the supplier for processing.
Finally, the items are checked during receipt of the delivery. The receiver, which is usually the
Central Supplies department, uses the purchase order as basis for accepting the delivered items that
should be checked for indents and damages. Afterwards, the said items are then released to the
requesting department.

Inventory Control
Inventory is one of the biggest expenses for most medical institutions (Johnston, 2014). Inventory
control plays an important part in refining the quality of health care services since lives of people are on
the line and medical costs are increasing.

Strategies in improving inventory control in the health care facility:

 1. Ensuring Shipment Accuracy
Checking shipments for accuracy means ensuring that the received items are the ones ordered
and the supplies are free from possible damages during transit.

2. Aligning with Sales Projections

Coming up with an inventory tracking report in comparison with actual sales proves to be a
challenge in the field of medicine. However, it is necessary to prevent wastage, identify trends,
and ensure that there is no excess inventory.

3. Complying with Regulations

The health institution should be responsive to the current trends and needs of the highly
regulated health care industry. The regulators monitor health institutions and determine the
success or failure of companies to serve the best interest of the patients.

4. Establishing Buying Cycles

Buying cycles should be determined and understood by inventory personnel based on the
previous cycles, so that inventory ordering becomes manageable through the elimination of
shortages and overages. The said cycles determine the trends and adjustments that can be made
accordingly.

Item Master Maintenance

Since the importance of inventory control has been recognized, the usage of a materials
management system brings an advantage. In this system, the Inventory Item Maintenance screen has
many sections. The upper portion contains master information. Additional options appear after the
selection of an existing item. "Item Tab" is used for maintenance of the attributes of an inventory item,
such as product type, item class, item type, and others. If the balance and order activity is zero (0), items
can be deleted using this option. Users may set the product type to group similar items for sales analysis
and inventory reporting. Most of the inventory reports are based on a certain product type. The "Item
Availability" form specifies inventory levels across all warehouses.
Item Indents and Issues
There are some instances when items are damaged either upon receipt from the supplier or
during the move from the source to another location. Some suppliers allow return of goods that have
indents or the like, with a guarantee of replacement without any additional payments. This applies to
distribution and retail industries where the goods for sale are fast-moving. Normally, damaged items are
moved to another warehouse for them to be monitored.

Reorder Level and Minimum and Maximum Inventory Ordering

In a typical materials management system, reorder level is the minimum quantity of an item-that
a company has in stock, so when the stock reaches the stated minimum quantity, the item must then be
reordered (purchase order/production order).
A basic reordering method implemented in many ERPs and other inventory management
softwares is the Min/Max inventory ordering method. The "Min" value is representative of a stock level
that prompts a reorder, and the "Max" value is representative of a new targeted stock level that follows
the reorder. The main difference of these two—Max and Min—is often interpreted as the economic order
quantity (EOQ). Although the Min/Max method is an unpolished method for inventory ordering, its
settings could be adjusted to provide better inventory performance (Vermorel, 2014).

Enquiries and Quotations for Drugs, Consumables, Assets, and

General Items
According to Webrino (2018), the followilig documents are required in the materials management
process:
 1. Enquiries — The enquiries mark the beginning of the purchasing process. These establish the
relationship between the entity and the right supplier. The supplier provides information on the
availability and price of the required items.

2. Quotations — Quotations contain vital information regarding the requirements which include
price, delivery details, payment terms, and etc. Companies usually review two to three quotations
before selecting the supplier.

3. Orders — The buyer shows the intention to purchase the required item by issuing a purchase
order. A purchase order is placed to signify intention to engage in commercial operations for a
specific product or service. Upon agreement, the order becomes a contract between the health
care institution and the supplier.

4. Invoices — An invoice is also called a bill. It is a commercial document that indicates the product,
the ordered quantity, and the agreed price. The supplier issues this to the buyer to show the
products and services that were sold or provided to the buyer.

5. Documents — Documents are statutory requirements used during purchase and sales
transactions. These ensure smooth transition and completion of the process.

Comparison of Quotations and Preferred Vendors

Purchase Quotations
A purchase quotation is a document for requesting prices and delivery information from a vendor
before the purchase order. It can be created then sent to a vendor. When a response from a vendor is
received, with a list of prices and delivery dates, the information can be entered in the purchase quotation.
In this way, the complete history of the sourcing process can already be stored in the system. From the
quotation, the right vendor for the purchase can be chosen based on the tracked information. It helps in
lessening expenses, improving the quality of the product or service, and increasing on-time delivery. A
purchase quotation report allows the comparison of offers in order to pick the appropriate vendor for the
purchase scenario. Afterwards, the purchase order can already be created from the selected quotation.

Preferred Vendors
Companies typically maintain a list of preferred vendors from whom inventory items are usually
purchased. They look for a vendor who has on-time performance, offers reasonable costs, provides high
quality products and services, offers fully licensed, bonded, and insured products and services, and has
good business practices.

Purchase Requests, Orders, and Approval

Purchase Request
 A purchase request or purchase requisition is a document that notifies the purchasing
department that certain items or services need to be replenished. The document stipulates a timeframe
and required quantities for the requested items. In certain instances, it also contains authorization to
acquire assets. For enhanced accountability and for documentation purposes, some companies require a
purchase requisition for all purchases, but others only require them for specific kinds of purchases, such
as those that would require greater capital outlay (SAP, 2012).

Purchase Orders
A purchase order is a legally binding contract which shows that the seller has already accepted
the order issued by the buyer (SAP, 2012). It should contain: information about the buyer and seller
(namet address, contact details, and etc.); order number and order date; item description (quantity, unit,
and total price); shipping information (shipping date and address); billing address; and the authorized
signature.

Approval Process
The person who creates the document, either a purchase request or order, is the originator. When
the said originator adds document/s to the materials management system, the system checks for any
approval requirements. If the document fails to meet the approval requisites, the originator is notified
that the document needs approval. The document is temporarily saved as a draft.
When the approval process is launched, an internal request is immediately sent to the first
approval stage. This request is received in the Messages/Alerts Overview window, and the approver can
access the document. Approval can be done through a mobile phone if the devices are integrated. An
internal notification goes back to the originator with a link to the rejected document when the approver
rejects the document. The originator can amend the document, and the approval procedure will continue
until the conditions are adequately satisfied (SAP, 2012).

Receiving and Tracking Items

The following policies should be followed for the proper receipt and inspection of goods (The York college,
2017):

1. Signing for Deliveries – The person who receives the delivery should inspect the delivered items
before signing the receiving document and the packing list. Then the document should be
submitted to the appropriate department for reconciliation.

2. Refusing Delivery – The receiving department should refuse to accept any shipment if the
packaging appears to be damaged or if there is any item that does not have a corresponding
purchase order.

3. Record Retention – The packing list should be provided to the receiving department during
delivery to ensure that there is proper documentation since it is are taking possession and legal
ownership of the delivered items. If no list was provided, the department should request the copy
from the supplier. All files should be kept according to the guidelines of the entity. This helps track
partial and staggered deliveries.
 4. Inspecting a Shipment – The personnel receiving the items should inspect the goods to ensure
that the following minimum conditions are met:
a) The received items match the requirements stated in the purchase order (type, description, color,
and etc.).
b) The quantity is correct.
c) The item has no damage, discoloration, and issues.
d) The quantity per unit of measurement is accurate (e.g., one dozen = 12 pieces).
e) Packing list, certifications, and other delivery documentation are completely provided.
f) Perishable items should be in good condition and have not reached the expiration dates.
g) The items are functioning properly.

5. Partial Deliveries – When items are delivered partially without proper notification from the
supplier, the receiving personnel should advise the Purchasing department for approval and
further instructions. This should also be typically noted in the packing list or the receiving
document.

6. Tracking of Goods – Goods can be easily tracked/traced when they are managed by serial number
or batch. Through that, aging of products can also be monitored based on how long they have
been in the warehouse.

Purchase Returns along with Returnable/Non-Returnable Gate

Pass
Defective or substandard quality goods, incorrect order delivery, and deteriorated purchased and
sold items are usually common in business. These lead to purchase or sales returns. When purchased
goods are returned, the materials management system updates inventory levels to reflect the decrease
in quantity.
Movement of inventory is not limited to purchase returns. Supplies and equipment are also
sometimes required to be taken out of the department for repairs or consignment. For temporary
movement, a returnable gate pass is issued, whereas for permanent movement, a non-returnable gate
pass is given. The system can be configured to track returnable and non-returnable items or equipment.
It can also be set to monitor due dates for returnable items and to provide detailed reports about the
status of different inventory items.

Consignment Stock Receipt, Consumption, and Regularization

In the process of consignment, the vendor or consignor issues materials to the receiver or
consignee, and these materials are stored in the consignee's premises. The vendor maintains legal
ownership until such materials are removed from consignment stores. The invoice is due at
predetermined intervals. In addition, customers can also arrange to take over ownership of the remaining
consignment material after a certain period (SAP, 2011).

Expired Stock and Quarantine

Expired Stock/Inventory
 Upon reaching their expiration dates, some goods, such as food and medicine, can no longer be
utilized. In rare instances, they may be sold to other parties at lower costs. Expiration dates and decrease
in values of items must be reflected in the financial records so discrepancies in financial statements will
be prevented. The amount that reduces inventory in the records is recognized as a loss which equates to
a reduction in profit (Keythman, 2017).

Quarantine Stock/lnventory
When undecided about how to handle defective goods, whether to be sold as scrap, reworked,
returned, or used as it is, a quarantine location or warehouse can be used to temporarily house them until
a final decision is reached.
Inventory is put into quarantine if it is initially rejected during (Infor LN Warehousing, 2018):

• Production, upon completion of an operation, when specified as "Move Rejected End Item to
Quarantine."
• Inbound inspection upon receipt of:
✓ Manufactured end items
✓ Purchased items
✓ Sold items on sales return orders
✓ Enterprise planning distribution orders
✓ Outbound inspection upon issue of materials to production.

Drugs and Consumable Issues and Returns to Patients

Nagarajan (2017) affirms that 30 to 50 percent of hospital charges are actually attributable to
diagnostics, drugs, and consumables; and doctors get only between 10 to 20 percent. For both hospitals
and patients, drugs and consumables take up the bulk of expenditure. This is why materials management
is critical for hospitals to optimize the investment in these kinds of consumable assets.
While some hospitals have functional inventory databases, the lack of integration does not give
them holistic information, and this affects decision-making, both on a managerial level and during day-to-
day operations. For instance, some drugs are misplaced or misappropriated, or shortages and surpluses
may occur as a result of improper inventory controls in a traditional system (Infor LN Warehousing, 2018).
This is where materials management system becomes advantageous. It provides an overview of the entire
institution's purchasing and inventory control processes. As a result, decision-makers can have more
reliable information and can monitor the bigger picture.

Issue Methods
Inventory management is a crucial function for any product-oriented business. Common
inventory handling methods include:

a. First In, First Out (FIFO) - Inventory items are sold based on the order they are purchased. This is
the most common technique.
b. Last In, First Out (LIFO) - Last items to enter the system are sold first. This is common among non-
perishable items like petroleum, minerals, and metals.
 c. First Expired, First Out (FEFO) - Materials are sold based on the dates they should be consumed,
regardless of when they were purchased.

Generic Tax Formula Configurations

Materials management system usually allow tax rates to be defined internally via tax codes, or imported
from an external source. Tax configurations are usually accounted on a per country basis. The following
taxes that can usually be processed while posting documents are

• tax on sales md purchases,

• additional taxes Eke VAT,
• sales and use tax in USA, and
• withholding tax like income tax in India.

The automatic calculation of the tax dues during the purchasing process makes the process less
susceptible to clerical errors.

Periodic Physical Stock Taking and Adjustments with Tracking

An inventory count is a process where a business physically counts its entire inventory. A physical
inventory may be mandated by financial accounting rules or tax regulations to place an accurate value on
the inventory, or the business may need to count inventory so component parts or raw materials can be
restocked. Businesses may use the following tactics to minimize the disruption caused by physical
inventory (CTI Reviews, 2016):

• Inventory services provide labor and automation to quickly count inventory and minimize
shutdown time.
• Inventory control system software can speed up the physical inventory process.
• A perpetual inventory system tracks the receipt and use of inventory, and calculates the quantity
on hand.
• Cycle counting, an alternative to physical inventory, may be less disruptive.

The materials management systems offer all of these in addition to the barcode and RFID capability
which are supplementary technologies placed to give the institution more accurate and less burdensome
inventory counts.

Key Points to Remember

✓ To successfully manage information, many hospitals implement a form of materials management
information system (MMIS). The aforementioned system can be used to manage functions like
purchasing, accounting, inventory management, and patient supply charges.
✓ Purchasing request could be used as a first step in the process of purchasing. This could be
followed by a quotation before proceeding to the purchase order depending on the process
preferred by the management.
✓ Inventory control plays an important role in refining the quality of health care services and
different strategies can be employed to ensure efficiency. These strategies include ensuring
 shipment accuracy, aligning with sales projections, complying with regulations, and establishing
buying cycles.
✓ The MMS can handle issues such as item indents and reorder level.
✓ There are three issue methods that are currently used in the health care industry: First In, First
Out (FIFO); Last In, First out (LIFO); and First Expired, First Out (FEFO).
✓ Periodic physical stock taking or inventory count may be mandated by financial accounting. MMS
have barcode and RFID that can be used as tools to ensure accurate and convenient counting.
 LESSON 13: CLINICAL DATA REPOSITORIES
Clinical Data Repositories
Nowadays, most institutions have existing clinical data repositories (CDR). in electronic or written
format, to represent an aggregated database of clinical information. The repositories usually house
multitude of laboratory results, diagnostic reports, and various clinical documentation. These data readily
searchable and exportable, often because the information is gathered from standard procedures
(Robertson and Williams, 2016). The repositories integrate physician-entered data with data from
different existing information systems including laboratory, radiology, admission, and pharmacy. They are
placed where both clinical data and other data of interest, such as external data sources and financial
data, are assimilated (Carter, 2001).
A clinical data repository can successfully depict the same sample across different points in time,
from varying sources both within and outside the health institution. Common kinds of available
informat.on in the CDR are listed below:
 Patient demographics
 Immunizations
 Patient's primary care provider
 Diagnoses
 Medication list
 Procedures
 Allergies
 Laboratory results
 Hospital in-patient visits
 Social history
 Emergency department encounters
 Vitals
 Outpatient practice visits
Maintaining them poses a lot of advantages since the longitudinal view of a patient's medical record can
assist in improving patient experience, and having information about prior test results and procedures
leads to more informed patient care decisions and helps avoid redundant treatment.

CDR Integration with HIS

Bergeron (2013) describes a clinical data repository as a systematically structured and gathered
"storehouse" of patient-specific data, which is usually mirrored from a clinical application, or
supplemented with data from other clinical systems. Since it is maintained as a separate database
particularly created in aiding decision analysis, the main application avoids computational loading, and
response time to a query is improved. Moreover, because almost all simple, customized, or complex
patient records are mirrored in it, queries are possible without sacrificing the performance of the source
applications. Furthermore, since the data typically originated from one source with little to no
manipulation, near real-time retrieval of clinical data is possible.
There are different levels of integration in the said repository. These levels depend on locations,
indices catalogues, semantic translations or equivalences, syntactic structures, and links to external
information. They influence functionality by setting constraints on how easily someone can make queries
for any of the contents. The integration structure from the CDR to the laboratory information system, for
example, may be different for radiology or pharmacy. These differences might mean that a user may only
access certain types of information, and use particular types of queries from a given information system
depending on the restrictions which were set during the integration process. The aforementioned
restrictions vary in terms of the user's access. While some CDRs are fairly open, others are restricted either
to employees of an institution or to members of some research network. Access control to the CDR
functions as a safeguard uphold data security and integrity.
Wade (2014) emphasizes that the longitudinal nature of the CDR requires a way of linking various
observations of the same identified subject. Most repositories usually contain personally-identified
however, due to privacy issues, they only release de-identified data which lead to the data in a dataset.
The lack of identifiers could also prevent the linking of data for somepatients. Presented below (Table
13.1) are the different types of clinical data repositories that Wade classified according to factors
described above.

Table 13.1 Types of clinical data repositories

Repository Type Definition
Study A database that collects observations for a specific
clinical research study
Electronic Health Record A database of observations made as a result of
direct health care
Registry Observations collected and organized for the
purpose of studying or guiding particular
outcomes on a defined population; associated
studies are either multiple or long-term and
evolving over time
Warehouse A repository that adds levels of integration and
quality to the primary (research or clinical) data of
a single institution to support flexible queries for
multiple uses; is broader in application than a
registry
Collection A library of heterogeneous datasets from more
organizations than a warehouse or more sources
than a registry, organized to help users find a
particular data set, but not to query for data
combined across datasets
Federation A repository distributed across multiple locations,
where each location retains control over access to
its own data, and is responsible for making the
data comparable with the data of other locations

These repositories are beneficial in consolidating patient information, a disadvantage is that most
CDRs are only integrated with clinical data. Laboratory results, diagnoses, and demographics might be
available in one platform, but overall patient satisfaction, the amount of time a patient had-to wait before
being treated, and other information not directly related to patient care might be unavailable.

Multiple Views for Patient Medical Record

Information on patients is typically scattered across multiple subsystems. A clinical data reposito
standardizes data from disparate sources into a cohesive format. It comprises numerous tables which
offers a partial view of patient information (Gensinger, 2014). Its structure allows data to be extracted
along dimensions such as time (by year, month, week, or day), location, or diagnosis. These data can often
be accessed in smaller units within the same dimension. For instance, a user can view the number of
patient with a certain type of diagnosis, laboratory result, or prescription within a year, then a month in
that year andfurther into a day in that month. One can also access how many times a particular procedure
has be performed at all locations within a health system, and then see the aggregate amount per region
or per facility. It helps organizations to transform large amounts of information from distinct transactional
files into a unitary decision-support database (Wager, Lee, &amp; Glaser, 2013k

Ball and Douglas (2013) elaborate that a well-deployed clinical repository has multiple
advantages. First advantage is the CDR function to provide longitudinal views of patient information. It is
often organized primarily around patients and secondly around visits or encounters, a method and chart
that results easily accommodates views that span multiple visits. This allows clinicians to trend and chart
results independent of the visits and test panel organization. For example, a clinician could study the trend
of a patient's blood sodium levels over the past six months independent of other factors.

Another advantage is its capability to provide access to information when needed. Since it
receives information from a multitude of feeder systems, it can create a "one-stop shopping"
environment. This is done by allowing the clinical staff to access a variety of patient-focused information
through a consistent and easy-to-use graphical interface (GU). The GUI access can be deployed through
hand-held devices, bedside computing devices, computers in physician's offices, or computing devices in
nursing stations. In any case, this wide variety of information access moves far closer to deployment
ofinformation at the point ofcare.
Finally, CDR provides a cross-continuum view of information since it allows information to be
gathered and viewed from sources other than an acute setting. This type of ambulatory-focused
information combines with the acute information to give clinicians a new level of insight into the wellness
of their patients.

Data Visualization of Laboratory Results and Vitals

Data collected through an electronic health record system may be retrieyed at the request of an
authorized user, whether a physician, medical technologist; nurse, or radiologist. The electronic health
record may present patient care information as text, tables, graphs, sounds, images, full-motion video, or
signals on an electronic screen, phone, pager, or paper (Bronzino &amp; Peterson, 2014).

Unfortunately, analyzing trends and patterns from large data sets can be a challenging process.
This is where data visualization, the art of representing data in a pictorial or graphical format, becomes
useful. It helps in simplifying a wide array of information, and it allows decision-makers to derive analytical
results from the information presented visually. Through this, correlations, patterns, and trends which
might be undetected from text-based clinical data can be revealed and recognized with more ease.

For example, the physician can easily review the results of multiple chest x-rays obtained over the
course or years when deciding ifa nodule has grown. This information would not have been accessible
when basing on textual clinical data alone. Moreover, patients suffering from specific diseases that require
ful charting or monitoring of laboratory values, including anticoagulation or blood sugar values, can
understand what is expected in their care because of better means of data presentation (Figure 13.1).
 Visualization of clinical data is increasingly becoming an important tool in decision-making. The
graphical representation feature of most clinical data repositories enables scenario analysis, which helps
users use different kinds of filters in order to change the level of information that may be seen. Common
filters include age and gender, in order to assess outcomes of certain interventions based on isolating
certain factors. This kind of analysis is a good opportunity in empowering the frontline staff by giving them
straightforward data which will efficiently and effectively facilitate the performance of their tasks (Rains
& McCuistion, 2018).

KEY POINTS TO REMEMBER

 Clinical data repositories (CDR) integrate physician-entered data with data from different existing
information systems including laboratory, radiology, admission, and pharmacy.
 A CDR is a systematically structured and gathered "storehouse" of patient-specific data, which is
usually mirrored from a clinical application, or supplemented with data from other clinical
systems.
 Repository types include study, electronic health record, registry, warehouse, collection, and
federation.
 CDRs offer a cross-continuum view of information since they allow information to be gathered
and viewed from sources other than an acute setting.
 Data visualization helps in simplifying a wide array of information, and it allows decision-makers
to derive analytical results from information presented visually.
 LESSON 14: ETHICS, PRIVACY, AND SECURITY
Ethics in Health Informatics
Technology helped in the modernization of the health care industry; however, this made
practitioners to be dependent on the use of mechanical aids in providing patient treatment. Conversely,
human values should continue to govern research and the actual practice in health care.
Health care informatics covers issues on honorable actions and proper and improper behaviors
in the field of health care. However, most health practitioners are not familiar with ethical issues even if
some issues have been controversial.
Nowadays, privacy and confidentiality are among the popular sources of debate. However, more
important issues such as the use of appropriate informatics tools in clinical settings, determination of
users, system evaluation, system development, and many others need attention. These and other
questions on the various legal and regulatory requirements need to be addressed (Goodman, 2016).
Listed below is a set of ethical principles for appropriate use of decision-support systems, particularly in
informatics, as described by Shortlife and Cimino (2013).
1. A program should undergo appropriate evaluation prior to use in clinical practice. It should
perform efficiently at an acceptable financial and timeframe cost.
2. Adequate training and instruction should be completed before proceeding to the
implementation.
3. A qualified health professional should be assigned to handle concerns regarding uses,
licenses, and other concerns. The software systems' applications should not replace functions
such as decision-making.

Information systems store patient's records that can be retrieved when needed. These records
assist in the dispensation of health care or other supplementary services which are part of health
informatics. Health informatics is guided by health information ethics defined as the application of the
principles of ethics in the domain of health informatics. The three main aspects of information ethics are
general' informatics, and software ethics (Samuel & Zaiane, 2014).

General Ethics
In public health, general ethics guide the reasoning and decision-making of all people and
organization involved in health care. Two of tile ethical principles a health professional must uphold are
autonomy and beneficence and non-maleficence.
1. Autonomy
Autonomy is defined as the idea of either allowing individuals to make their own decisions in
response to a particular societal context, or being free from external influence or control. Electronic health
records (EHR) must maintain respect for patient autonomy, and this entails certain restrictions about the
access, content, and ownership of records. A compromise must be reached between levels of patient
autonomy and quality of patient records. When patients are given too much control over their EHRs, this
could defeat the purpose of the use of such document because critical information might be modified or
deleted without the knowledge of the health professionals. Limiting patient access and control over
patient records improves document quality because patients can also verify their own records (Mercuri,
2010).

2. Beneficence and Non-maleficence

 These two principles are respectively defined as do good and do no harm. In health informatics,
beneficence relates most significantly with the usage of stored data in the EHR system, and non-
maleficence with how the stored data is protected.
Deeply integrated EHR systems will contain substantial amounts of raw data, and great potential
exists for the conduct of groundbreaking biomedical and public health researches. These kinds of research
will be beneficial to both the individual patient and the society. With this in mind, new EHR systems should
be developed with the capacity to allow patients to release information from their EHRs which can be
valuable to researchers and scientists. Similarly, the available consolidated data from clinical data
repositories will allow health care professionals to provide the best possible treatment for their patients,
further upholding the principle of beneficence.
However, the integrated data storage in health informatics is also a breeding ground for varying
threats. Temporary outages, at a minimåm, might prevent health care professionals from performing
necessary procedures. At Worst, it could even result in significant patient mortality. Total system failures,
however, may cause even greater damage. In order to avoid these instances, all data must have multiple
back-ups for fast and easy recovery. Since medical records contain very sensitive information about an
individual, the highest level of data security possible should also be upheld. Vulnerabilities in security put
patients at a risky position, and might ultimately lead to the violation of the principle of non-maleficence
(Mercuri, 2010).

Informatics Ethics
Informatics ethics is about the ethical behavior expected from an individual assigned to handle
information, asprescribed by the International Medical Informatics Association (2016). It follows seven
principles:

1. Principle of Information-Privacy and Disposition

Everyone has the fundamental right to privacy. Every individual should ensure that he or she has
control over the collection, access, use, communication, manipulation, storage, linkage, and disposition
ofdata about himselfor herself.
2. Principle of Openness
The control measures of particular data should be disclosed to the concerned individual in an appropriate
and timely fashion.
3. Principle of Security
Legitimately collected data should be protected through all appropriate measures against access, use,
modification or communication, manipulation, linkage, loss, degradation, and unauthorized destruction.
4. Principle of Access
Authorized individuals should be given access to electronic health records and the right to correct the
data with respect to their completeness, accuracy, and relevance.
5. Principle of Legitimate Infringement
The right to privacy and control over personal data should be conditioned by the appropriate,
legitimate, and relevant data-requirement of a democratic society and by the equal rights of others.
6. Principle of the Least Intrusive Alternative
Any infringement of privacy rights should occur in the least intrusive manner and with the amount of
interference with the rights of the affected parties.
7. Principle of Accountability
Any infringement must be justified to the concerned individuals in a timely and appropriate
fashion.
Software Ethics
Health informatics ethics relies on the use of the software to store and process information. It
follows the activities carried out by the developers might affect the end-users. Therefore, software ethics
is the ethical duties and responsibilities of software developers to the stakeholders (society, institution,
and employees, and the profession). They should execute all system activities with the best interest of the
society in mind. They should disclose any threats or known defects in the software. They ensure that
completed activities serve the best interests of the institution and its employees. They should be
straightforward about their personal limitations and qualifications. Finally, they must build products that
meet the professional standards through testing and detailing unresolved issues. In support of the
mentioned responsibilities of software developers, the management should require ethical approaches in
software development (Samuel & Zaiane, 2014)

Privacy, Confidentiality, and Security

Privacy and confidentiality are often used interchangeably, but they are not synonymous. Privacy
generally applies to individuals and their aversion to eavesdropping, whereas confidentiality is more
closely related to unintended disclosure of information. For example, someone who is spying on a certain
person to find out about his or her visit to an acquired immunodeficiency syndrome (AIDS) clinic is a
violation of that person's privacy. On the other hand, if someone breaks into the clinic to view an
individual's patient record, that act is in violation of confidentiality.
There are numerous significant reasons to protect privacy and confidentiality. First, privacy and
confidentiality are widely regarded as rights of all people which merit respect without the need to be
argued, or defended. Second, protection of these rights is ultimately advantageous for both individuals
and society. Patients are more likely to be comfortable to share sensitive health care data when they
believe this information would not be shared inappropriately. This kind of trust essentially establishes a
successful physician-patient or nurse-patient relationship, and enables the practitioners to perform their
jobs better. Furthermore, the protection ofprivacy and confidentiality benefits public health. When
people are not afraid to disclose personal information, they are more inclined to seek out professional
assistance which helps in diminishing the risk ofincreasing untreated illnesses andspreading infectious
diseases (Goodman, 2016).
When patients trust medical professionals and health information technology enough to disclose
their health information, the latter will have a more holistic view of patients' overall health and both
health care professional and patient can formulate more informed decisions. In circumstances in which
breaches of privacy and confidentiality occur, serious consequences for the organization await, such as
reputational and financial harm, or personal harm to patients. Poor privacy and security practices
heighten the vulnerability of patient information and increase the risk of successful cyber-attacks (USA
Department of Health and Human Services, 2015)

Levels of Security in Hospital Information System

Safeguards are the solutions and tools which may be utilized to implement security policies at
different levels of health organization. At the administrative level, they may be implemented by the
management as organization-wide policies and procedures. Mechanisms can be put in place to protect
equipment, systems, and locations at the physical level, while automated processes to protect the
software and database access and control can be implemented at the technical level. Examples are
enumerated in Table 14.1 below, as discussed by the USA Department of Health and Human Services.
 It is important to note that the types of safeguards may be prescribed or restricted by law.
Another important consideration is the cost-benefit principle. If it is not cost effective for an institution to
avail of an expensive technology to mitigate a risk to electronic health information, an alternative is to
require the taffto follow a new administrative procedure that equally reduces that risk. Conversely, if an
institution cannot afford to place additional burden on the staff due to possibilities of human error, it may
choose to purchase a technology that automates the procedure in order to minimize the risk.

Regardless of the type of safeguard (Table 14.1) chosen to be implemented, it is important to monitor its
effectiveness and regularly assess the health IT environment to determine if new risks are present.

Table 14.1 Administrative, Physical and Technical Safeguards for HIS

Administrative Safeguards • Regular risk assessment of the health IT
environment
• Continuous assessment of the
effectiveness of safeguards for electronic
health information
• Detailed processes and procedures for
viewing and administering electronic
health information
• Training for the users of health IT to
appropriately protect electronic health
information
• Reporting of security breaches (e.g,. to
those entities required by law or contract)
and continued health IT operations.
Physical Safeguards • Placing office alarm systems
• Locking offices and areas that contain
computing equipment that stores
electronic health information
• Having security guards that make regular
rounds in the vicinity
Technical Safeguards • Configuration of computing equipment to
ensure (e.g., virus checking, firewalls)
• Using certified applications and
technologies that store or exchange
electronic health information
• Setting up access controls to health IT and
electronic health information (e.g.,
authorized computer accounts)
• Encryption of electronic health
information
• Regular audit of the health IT operations
• Having backup capabilities (e.g., regular
backups of electronic health information
to another computer file server)u
Source: Reassessing your security practices in a Health IT environment: A guide to small health care
practices (Office of the National Coordinator for Health Information Technology, n.d.)

The National Research Council (1997) emphasizes that technological security tools are essential
components of modern distributed health care information systems, and that they serve five key
functiom.

1. Availability - ensuring that accurate and up-to-date information is available when needed at
appropriate places
2. Accountability -- helping to ensure that health care providers are responsible for their access to and
use of information, based on a legitimate need and right to know
3. Perimeter Identification — knowing and controlling the boundaries of trusted access to the
information system, both physically and logically
4. Controlling Access - enabling access for health care providers only to information essential to the
performance of their jobs and limiting the real or perceived temptation to access information beyond
a legitimate need
5. Comprehensibility and Control -- ensuring that record owners, data stewards, and patients
understand and have effective control over appropriate aspects of information privacy and access

Levels of Security in the Laboratory Information System

McPherson and Pincus (2017) narrate the following flow of information, described in Table 14.2,
in a specific portion of the hospital information system, that is, the laboratory information system.

Table 14.2 Key Steps in Laboratory Information Flow for a Hospital Patient
Step Description
Register Patient The patient record (e.g., ID Number, name, sex,
age, location) must be created in the LIS prior to
the test(s). The LIS usually receives these data
automatically from the hospital registration
system when a patient is admitted.

Order Tests The attending physician orders the tests for the
patient and the procedure is requested as part of
the laboratory's morning blood collection rounds.
These orders are entered into the CIS and they are
sent to the LIS electronically.

Collect Sample The LIS prints a list of all patients who have to be
drawn which also includes the appropriate
number of sample barcode labels for each patient
order. Each barcode contains the patient ID,
sample contained, and laboratory workstation
which is used to sort the tube once it reaches the
laboratory. An increasingly popular approach is for
caregivers or nurses to collect the blood sample.
Sample barcode labels can be printed (on
 demand) at the nursing station on an LIS printer or
portable bedside printer prior to collection.
Receive Sample Once the sample arrives in the laboratory, the
status is updated in the LIS from "collected" to
"received." This is done by scanning each sample
container's barcode ID into the LIS. Once the
status becomes "received," the LIS then transmits
the test order to the analyzer that will perform the
required test.

Run Sample The sample is loaded to the analyser, and the

barcode is then read. No work list is needed
because the analyser knows what test to perform
from the order provided by the LIS. However,
when test are performed manually, the
technologist prints a work list from the LIS. The
work list should contain the names of the patients
and the test ordered on each and next to each test
is a space the names of the patients and the tests
ordered on each and next to each test is a space
to record the result.
Review Results The analyser then produces the results and sends
the same to the LIS. The result is only viewable to
the assigned technologists until it is released for
general viewing. The LIS can also be programmed
to flag certain results – for example, critical values
– so the technologist can easily identify what
needs to be repeated or further evaluated.
Release Results The technologist is responsible for the release of
the results. The LIS can be programmed to
automatically review and release normal results or
results that fall within a certain range. This
approach reduces the number of tests that a
technologist has to review. The results are
automatically transmitted to the CIS upon release.
Report Results The physician can now view the results on the CIS
screen. Reports can be printed when needed.

The aforementioned principles regarding administrative, technological, and physical safeguards can be
applied similarly to the laboratory information system in order to improve its security. Examples are listed
in table 14.3.
Table 14.3 Administrative, Physical, and Technical Safeguards for LIS

Administrative Safeguards • Continuous training for the users of the

LIS
• Periodic review of standards used to
identify results that should be flagged
• Review of the authorization and
supervision policies
• Strict implementation of the rules and
regulations for the testing procedures
• Release and dissemination of guidelines
on the proper disposal of laboratory
specimen
• Enforcement of strict policies on the
proper use of laboratory workstations

Physical safeguards • ensuring the periodic maintenance of

laboratory equipment
• Having biometrics or other security
measures for laboratory process
• Maintenance of controlled temperature
both for equipment and specimen
• Use of appropriate personal laboratory
safety equipment
Technical safeguards • Presence of automated identity
confirmation procedures for users
requesting access
• Regular updating of passwords
• Requiring different authorizations based
on user level
• Capacity of the unit to automatically log-
off after a specific period of inactivity.

Philippine Data Privacy Act of 2012

Business process management, particularly involving health information technology, is an
increasingly growing industry within the Philippine economy. With total IT expenditure, reaching $4.4
billion in 2016, the industry is forecasted to go beyond doubling itself by 2020. In addition, Filipinos utilize
media heavily, with a whopping 3.5 million users on Linkedln, 13 million on Twitter, and 42.1 million on
Facebook (Wall, 2017).
Given the rapid evolution of the digital economy and heightened international data trading, the
Philippines has decided to strengthen its privacy and security protection by passing the Data privacy Act
of 2012, with an aim "to protect the fundamental human right ofprivacy of communication while ensuring
free flow of information to promote innovation and growth" (Republic Act No. 10173, Ch. I, Sec. 2).
The Act applies to individuals and legal entities that are in the business of processing personal
information. The law applies extraterritorially, applying both to companies with offices in the Philippines
and even those located outside that use equipment based in the Philippines. It covers personal
information of Filipino citizens regardless of the place of residence. The main principles that govern the
approach for this Act include transparency, legitimacy of purpose, and proportionality.
Furthermore, in the Data Privacy Act of 2012, consent is one of the major elements highly valued.
The Act provides that consent must be documented and given prior to the collection of all forms of
personal data; and the collection must be declared, specified, and used for a legitimate purpose. In
addition, the subject must be notified about the purpose and extent of data processing, with details
specifying the need for automated processing, profiling, direct marketing, or sharing. These factors ensure
that consent is freely given, specific, and informed. However, an exception to the requirement of consent
is allowed in cases of contractual agreements where processing is essential to pursue the legitimate
interests of the parties, except when overridden by fundamental rights and freedom. Such is also the case
in responding to national emergencies.

Processing of sensitive and personal information is also forbidden, except in particular

circumstances enumerated below. The Data Privacy Act of2012 describes sensitive personal information
as those being
• about an race, ethnic origin, marital status age, color, and religious, philosophical, or political
affiliations,
• about an individual's health, education, genetic or sexual life of a person, or to any proceeding or
any offense committed or allegedly committed,
• Issued by government agencies "peculiar" (unique) to an individual, such as social security and
• marked as classified by an executive order or act of Congress.
The exemptions are
• consent of the data subject,
• pursuant to law that does not require consent,
• necessity to protect life and health of a person,
• necessity for medical treatment, and
• Necessity to protect the lawful rights of data subjects in court proceedings, legal proceedings, or
regulation

The provision of the law necessitate covered entities to create privacy and security program to
the collection of data, limit processing to legitimate purposes, manage access, and implement data
procedures.

The Act provides for different penalties for varying violations, majority of which include
imprisonment. violations include:
• unauthorized processing,
• Processing unauthorized purposes,
• Negligent access
• Improper disposal
• unauthorized access or intentional breach,
• concealment of breach involving sensitive personal information,
• unauthorized disclosure, and
• malicious disclosure.
 Any combination or series of acts enumerated above shall make the person subject to imprisonment
ranging from three (3) years to six (6) years, and a fine of not less than one million pesos but not more
than five million pesos (P5,000,000.00) (Republic Act No. 10173, Ch. 8, Sec. 33).

KEY POINTS TO REMEMBER

✓ Health informatics is the application of the principles of ethics to the domain of health informatics.
There are three main aspects of health informatics ethics: general ethics informatics ethics and
software ethics
✓ General ethics covers autonomy, beneficence, and non-maleficence.
✓ Informatics ethics refers to privacy, openness, security, access, infringement, least intrusion and
accountability.
✓ Software developers should consider the best interest of the society in general, the institution
and its employees, and the profession.
✓ Administrative, physical, and technical safeguards are placed to regularly monitor effectiveness
and assess the health IT environment.
LESSON 15: CHANGE MANAGEMENT IN HEALTH INFORMATICS
Change Management
Generally, there are four kinds of changes that all kinds of organizations might encounter, with
the likelihood of overlap among the conceivable outcomes.
a. Operational changes can influence the way dynamic business tasks are led, including the
computerization of a particular business segment.
b. Strategic changes occur when the business direction, in relation to its vision, mission, and
philosophy, is altered. For instance, changing the business technique from business growth to
increasing market share in the overall industry is a case of strategic change.
c. Cultural changes influence the internal organizational culture, for example, the way the business
is conducted, such as actualizing a CQI (continuous quality improvement) framework.
d. Political changes in human resources occur primarily due to political reasons of varying types,
commonly, changes that happen on top patronage levels in the government agencies.

Different sorts of changes typically have dissimilar impacts on different organizational levels. For
instance, operational changes tend to have the highest impact on the lower organizational levels, and
mostly affect frontline employees. Employees working at the upper levels might be indifferent to the
changes, which may cause significant distress to those attempting the implementation of change.
Conversely, the effect of political changes is more strongly felt on the higher levels of the
organization. When changes occur relatively in a bureaucratic organization, those working on the bottom
level often notice the change at the top (Lorenzi &; Riley, 2000).
There is no denying that organizational changes have varying degrees of impact on both the
organization, and in effect, its clientele. This lesson discusses change management contextualized in
health informatics, which is increasingly becoming a course of action that health institutions avail in order
to improve their services.
Changes are inevitable especially in organizations because they need to evolve to meet the
demands of the stakeholders which include global competition, changes in customer demand,
technological advances, and new legislation.
Organizations may even change the way they operate in order to cope with the demands.
Redefining roles, eliminating ineffective processes, or initiating new ways of working are considered minor
adjustments. Conversely, there are times when pressures necessitate major disruptions which transform
the culture; re-organize people, processes and systems; and change the organization's strategy radically.
For more than 100 years, change management has been evolving with its beginnings rooted in
health and job-related grief studies. Currently, most change management processes which are designed
to drive business transformations draw their inspiration from behavioral and social sciences and IT and
business solutions.

A survey on change management conducted in 2007 involving over 400 senior HR managers in
the US revealed the following reasons behind the percentages of organizations implementing or planning
change over the previous two years:
• New performance management process (58%)
• Relocation or facility closure (57%)
• Organizational culture changes (54%)
• New IT systems (51%)
• Change of strategy (45%)
• New financial/accounting systems (41%)
• Downsizing, layoffs (40%)
 • Operational changes resulting from new legislation, economic conditions, or
national/international events (30%)
• Product rebranding (26%) Acquisition (25%)
• Off shoring or outsourcing (16%)
• Merger (10%)
• Corporate ownership change (8%).

Meanwhile, in the health care industry, the following are factors that contribute to the changes:

1. Regulatory adjustments
2. Shifts in consumer behavior patterns
3. 3. Accelerated pace of IT development
Health care consumers want a more customized experience and greater opportunity to
participate in their health care decisions. This means that health care institutions need to adapt a more
innovative technology, implement an informed patient engagement strategy, and adjust their
organizational structures to drive better patient experiences which may result in numerous and rapid
changes (Quinn, 2017). However, technology alone is not enough. The truth of the matter is that no
technology can be successfully implemented without the human factor which intensifies the work
processes and gives the appropriate guidance. The need to find the right balance between technology and
human factor is necessary in the roadmap for organizational changes.
Another vital element in change management initiatives is communication. Information should
be shared so the stakeholders would be advised about the timing, nature, and importance of changes in
the business. Participation from management is crucial to the successful implementation of the planned
changes. Any change can only be successful when the employees are motivated towards the change and
are willing to accept the vision presented by the organization's leadership (Aljohani, 2016).

Those organizations which are able to manage change well will definitely survive and thrive. This
is basically the concept Of change management. The managers need to direct, control, and monitor the
changes to ensure that the Objectives are met. They must ensure that the employees adapt the changes
without disrupting the regular operations (Downey, 2008).

Change management process has a wide range of models with each model having its own
strategic approaches. The more common change practice examples include:

1. Kurt Lewin's Unfreeze-Change-Refreeze model

This three-step model was proposed by Kurt Lewin, founder of social psychology, in the 1950s. This is still
widely used as the basis for many change management strategies.
2. Proski's ADKAR' model
This acronym means "Awareness of the business reasons for change; Desire to engage and participate in
the change; Knowledge about how to change; Ability to implement change; and Reinforcement to ensure
change sticks" (ADKAR).
3. Kotter's Change model
This eight-step model was developed by John Kotter of Harvard Business School. Building a strong
collaborative team by using a solid strategy, creating effective communication channels, supporting staff
empowerment, using a phased and steady approach, and securing the change within an organization's
culture are the core concepts of this method (QuickBase, 2017).
Application of Change Management
Change management is defined as a series of tools, techniques, and processes aimed at
successfully effecting change. These tools support the application of other initiatives such as Six Sigma,
Customer Relationship Management (CRM), Total Quality Management (TQM), or Enterprise Resource
Planning (ERP), but can be implemented in a variety of contexts.
Downey (2008) enumerates the common tools and techniques that can be used during a change
initiative:
• Gathering information
• Mapping of the
• Gap analysis
• Business case development
• Project management
• Problem solving
• Negotiation skills

In addition, the progress of the change initiative can be measured against the objectives set by
the organization (Downey, 2008). The said objectives will be measured by the key performance indicators
(KPIs) which include reducing rework by x%, improving in stakeholder satisfaction, for example,
customer/employee surveys, reducing time to market, enhanced speed of delivery, and having good
return on investment (ROI) which is the total cost to implement the initiative versus total savings gained
from the initiative per period.
In the world of health care, some hospitals are reluctant and indignant towards the idea of
change; and they find it difficult to adjust. Thus, health informatics hopes to change the way health care
institutions conduct their business on a daily basis. Health care providers need to welcome change and
approach information technology with an open mind. Aziz (2007) emphasizes that a mechanism for the
transformation of business and clinical processes should be in place. By encouraging the adoption of
innovation in health care information technology by clinicians, therapists, nurses, and physicians, health
care providers can achieve key success factors (Table 15.1).

15.1 Key Success Factors

Key success factors at the leadership level health Key Success factors at the program level
care organizations

1. Setting the vision and strategy road map
for the organization
2. forming a governing body to set direction
and priorities and to allocate resources
3. designating of the organization's
executive sponsor departmental
champions and program manager
4. defining reporting requirements for the
project
5. setting and managing the users’
expectation
1. Clear and timely dissemination of
information
2. building a strong project leadership team
and other functional teams
3. providing proper training on the new
changes especially on the workflow and
technology
4. forming integrated teams to address and
resolve critical and complex issues
5. empowering staff and end users to
improve the process by removing barriers
and obstacles
 6. maintaining changes through by positive
reinforcement frequent
7. Frequent celebration of success by
acknowledging contributors thus keeping
the motivation and momentum
8. monitoring and constant measurement
of key indicators (e.g., using dashboard to
report progress and benchmarks
9. Involving those who are affected by the
change in decision-making (e.g., choice of
computer carts, COW)
10. Other creative actions and incentives e.g.
monthly prizes for high performing
teams, providing snacks and drinks.

Working with Physicians

Most physicians have patients in multiple hospitals since they are non-hospital employees.
Systems of health institutions may differ from each other which complicates the situation. Thus, they
should have clear. cut adoption methods to avoid any issues. Aziz (2007) lists some ideas for the success
of the transformation.
1. Communicate patiently the benefits of the changes in terms of patient care and safety.
2. Nominate physician leaders at the start of the program.
3. Use web, CBT, and other multi-channel learning and training opportunities.
4. Be ready and available to answer questions and clarifications.
5. Make sure that there is a process in place in handling enhancement requests and developments.

Training and Education in Health Informatics

Below is a list ofpractices that emphasize life-long learning in support of the change management
that must be initiated by the leaders of the organization (Aziz, 2007).
1. Provide instructor-led training classes to cover different shifts.
2. Present contemporary models of training.
3. Make computer laboratories available for practice (24/7).
4. Roll out accompanied by on-the-job/real-time training.
5. Summarize the steps and make cheat sheets handy.
6. Print easy to carry colorful booklets in a pocket.
7. Provide a short manual with key facts and how-to-tips.
8. Have well equipped training rooms.
9.Schedule train-the-trainer program to give enough time to practice.
10. Assign a super-user to keep people involved.
11.Provide the business process maps and process workflows.
12. Prepare a day-in-the-life scenario for the simulation.
13.Walk them through the flow several times until they are able to adapt.
14.Entertain and answer questions clearly and provide details.
15.Prepare the users by discussing some of the challenges and frustrations they might encounter in the
early stages of the rollout.
 Enumerated are the fundamental practices that management needs to embrace as its well-rounded
strategy (Aziz, 2007).

1. Align business leaders with clinical leaders by creating a governance structure.

2. Focus on the process design and map the workflow clearly.
3. Have due diligence to ensure a thorough organizational and business impact analysis.
4. Encourage the involvement of clinicians at various levels at the start of the project.
5. Show commitment by staying on the course and communicating the objectives clearly.
6. Have a strong program customized to address different needs.
7. Get feedback into the loop and work on it.
8. Have a 24 x 7 help desk to ensure that the program is well-structured and has ample support.
9. Select a couple of measurement criteria for benchmarking and system evaluation.

Health Information Profession

Role of Health Information Management Professionals

Health information management (HIM) professionals have a special skill set that qualifies them to
assume the role of privacy and security officers who take care of the storage, protection, and maintenance
of the information in the health care institution. This is coupled with their academic preparations,
experiences in the health sector, and commitment to the advocacy of patient care and professional code
of ethics (May, 2014).
HIM professionals should be committed to the timely and accurate collection and management
of data which cover the aggregation, analysis, and dissemination of patient health information. They
manage the said information and medical records, administer the computer information systems, and
standardize the coding systems for the diagnoses and procedures of the services provided to patients.
Such information is kept secure and private in accordance with state laws.

A career in health information management and health information technology is not limited to
data capture, documentation, and maintenance of clinical information but also includes data analytics
and interpretation, and management of the health information technology systems.
HIM professionals may fall into various job categories with varied titles, including
1. Health information management department director
2. Health information management system manager
3. Information security officer
4. Chief privacy officer
5. Health data analyst
6. Health record technician specialist
7. Clinical coding specialist
8. Patient information coordinator
9. Physician practice manager
10. Health information administrator
11. Revenue cycle specialist
12. Director of quality management
13. Health information manager
14. Health information technologist/technician
 These professionals also ensure that a patient is billed accurately and assure that the health care
information is compiled and analyzed to assist in making recommendations that can improve the health
services. They are also expected to devise policies that address concerns on the delivery ofhigh quality
health care and the availability of quality information for decision-making (May, 2014).

Philippine Health Information Profession

Advancements in ICT (information and communication technology) are upsetting not traditional
businesses, but even those not immediately thought of as probable beneficiaries—such as the health care
sector. From electronic patient records to the wireless transmittal of patient files for remote diagnosis,
improvements in communication and technology will lead to better delivery of health care services.
Telemedicine, or the use of electronic communications to transmit and exchange medical information and
data to provide patient treatment, is quickly gaining momentum within the country and the rest of the
ASEAN region.

With the increasing popularity of smart phones, Wireless tools, and other comparable technology,
primary care and specialist referral services, as well as remote patient monitoring and patient medical
health information, are undeniably improved with the help of telemedicine. Thailand, Singapore, and
Malaysia have started adopting health care IT solutions to bring the sector to the next level. In 2009
Singapore developed its National Electronic Health Record initiative, which permitted health care
practitioners in the country to access patient's records across the health care continuum. Malaysia
initiated a Hospital Implementation System in 1993, with its first telemedicine project in 1996, and
Thailand created its National Health Information Committee in 2010.
Likewise, the Philippines has developed an e-Health Strategic Framework and Plan for 2014 to
2020, whose objective is to utilize information and communication technologies in the health sector. This
wil assist in the delivery of health services and manage health systems for greater efficacy, with the
ultimate goal ofproviding universal health care for the Filipinos. One of the strategic goals of this
framework is to establish unified and coherent health and management information systems, to take
advantage of ICT to reach and provide better health services, and support the attainment of the UN's
Sustainable Development Goals. In line with this, the Department of Health (DOH) in Region IV-B has
launched the first interactive telemedicine system in Marinduque, and seemingly the entire country, at
the Dr. Damian J. Reyes Provincial Hospital. The system currently provides medical consultations and
diagnostics through video calls (De Dios, 2016).

Telemedicine in the Philippines

For an archipelago such as the Philippines the delivery of health care services might be proven to
be challenging. Fortunately, the rise of telemedicine within the region has been a beneficial turn of events
for the Philippine health care sector.

Multiple players in the telemedicine scene currently exist, ranging from mobile apps to call center
services. Some providers of over-the-phone telemedicine services are Medgate and Lifeline. Common
features include 24/7 call centers, diagnosis using images sent via email, medical certificates, and
treatment plan summaries. Telemedicine centers usually have a corresponding mobile app to facilitate
easier access. Unique to Lifeline, however, is video consultation with doctors, patient education, free
doctor or nurse home visits, and delivery of medication and prescriptions in exchange for a fixed monthly
subscription fee.
 Mobile. app-based telemedicine centers, on the other hand, include MyPocketDoctor and
MyDocNow„ These providers are usually in partnership with other international telemedicine centers.
Medway Healthcare Inc. offers the most comprehensive telemedicine services by using telefollow-up and
teleconsultation procedures. These applications are accessible online. It is the first medical clinic in the
philippines which mobilized the pre-employment medical examination (PEME).
Telefollow-up is a specialized application which notifies patients of the medical evaluations results
via text messages. Patients will know the status if they are fit to work or still have pending workups within
24 hours of PEME. On the other hand, follow-up teleconsultation takes care of the online communication
between the patient and the physician regarding the follow-up of medical results when the patient is
unavailable to get the results personally. The physician gives the necessary advice and schedules the
followup visit.
The specialist teleconsultation is also available which gives way to consultation despite distance
barrier, This application enables real-time consultation with a physician with the assistance of a nurse and
utilization of the appropriate telemedicine equipment. If the specialist needs to listen to the patient's
breathing, the nurse would place the telephonic stethoscope on the appropriate areas of the patient's
body and the sound would then be transmitted back to the specialist. The equipr»ent uses high-definition
cameras to focus on lesions or specific body parts. As for the test results, they are transmitted by using a
store-and-forward technology if real time option is not available. (Medway Health Inc., 2012).
The government pioneered nationwide telemedicine efforts, through research and service work
of the National Telehealth Center (UP-NTHC) of the University of the Philippines-Manila and funding from
the Commission on Information and Communications Technology (CICT). It implemented the Buddyworks
Telehealth project from 2004 to 2007. This uses a web-based and SMS-based telehealth platform.
Subsequently, the Department of Health (DOH, funding from 2011 to 2013) and Department of Science
and Technology (DOST, 2007 to present) supported the UP-NTHC's continuing telehealth program
expanding its geographic scope and telehealth innovations. From an initial 10 isolated and disadvantaged
sites, it grew to link over a thousand young doctors with clinical specialists based in the UP-Philippine
General Hospital and regional hospitals of the Cordillera Administrative Region and Eastern Visayas to
support them in their clinical decision making. Other DOH regional hospitals are being prepared by the
UP-NTHC to become telehealth hubs in the locale.

The RxBox diagnostic telemedicine device was incorporated in the government telehealth pr
through DOST's support. The first version was developed in 2007 by Dr. Alvin Marcelo and Sison of UP-
NTHC and UP Engineering in Diliman, respectively. The RxBox device included Luis that can measure blood
pressure, pulse rate, temperature, and even an electrocardiogram. Dr. Mar trauma surgeon, envisioned
that the RxBox would be used in ambulances transmitting a patient's clinical parameters via telehealth to
prepare better the emergency room clinicians to receive these critical patient Dr. Sison continued to
develop the second version beginning 2012, this time with Dr. Portia Marcelo*. They added sensors that
will detect fetal heart beats and the pregnant woman's uterine contractions, and envisioned its use in
rural health units. The objective was to equip these rural centers with lifesaving diagnostic tools and better
manage health information. Clinical data gathered by the RxBo is exchanged with the community health
information tracking system (CHITS) electronic medical records system; in the event of clinical dilemma,
data can be pulled from CHITS and transmitted to specialists for teleconsultation. In the latter part of
2018, the seamlessly linked systems of RxBox, CHITS, and telehealth will be implemented in 1,000 rural
municipalities and with medical specialists in all regions nationwide.
KEY POINTS TO REMEMBER
✓ Change is inevitable and pervasive. Organizations are driven to change in order to respond to the
many pressures they encounter from their environment. These pressures include global
competition, changes in customer demand, technological advances, and new legislation.
✓ Change management is a series of tools, techniques, and processes aimed at successfully
effecting change.
✓ Health information management (HIM) professionals, credentialed with their academic
preparations work experiences, and commitment to patient advocacy and professional code of
ethics, have a specialized skillset that uniquely qualifies them to assume the role of both privacy
officials and/or security officials who store, protect, and transmit information in all media and
formats.
✓ One of the strategic goals of the e-Health Strategic Framework and Plan for 2014—2020 is to
establish unified and coherent health and management information systems to take advantage
of ICT to reach and provide better health services, and support the attainment of the UN's
Sustainable Development Goals.
✓ Telemedicine efforts from the government and other non-profit organizations have also ensued.
The National Telehealth Center is the leading research unit in the University of the Philippines
responsible for developing cost effective tools and innovations in the realm of information and
communications technology (ICT) for improving health care.