Introduction

A health information system (HIS) refers to a system designed to manage healthcare data. This
includes systems that collect, store, manage and transmit a patient’s electronic medical record
(EMR), a hospital’s operational management or a system supporting healthcare policy decisions.

Health information systems also include those systems that handle data related to the activities of
providers and health organizations. As an integrated effort, these may be leveraged to improve
patient outcomes, inform research, and influence policy-making and decision-making. Because
health information systems commonly access, process, or maintain large volumes of sensitive
data, security is a primary concern

Sharing information about health gives a clearer picture of health and illness across populations,
and this knowledge can help prevent the spread of disease and improve health outcomes. An
effective and integrated health information system (HIS) is the foundation of a strong health
system and key to making effective, evidence-based health policy decisions. Without health
information systems to inform decision-makers of where the health problems are and if the
health of a population is improving or getting worse, sound judgements cannot be made.
However, few developing countries have sufficiently strong or effective health information
systems. Often countries with the greatest need do not have access to reliable and timely
information, and when data are available, they are often out-of-date, making the challenge of
assessing trends even more difficult. Without investments in HIS countries risk making policy
and planning decisions arbitrarily, driven by political interests, anecdotal evidence and external
agendas.

Health Information Systems

Health information systems (HIS), defined by the World Health Organization as integrated
efforts to ‘collect, process, report and use health information and knowledge to influence policy
making, programmed action and research’, are essential to the effective functioning of health
systems worldwide. Routine HIS, such as those operated through health information departments
or national statistics offices, provide information on risk factors associated with disease,
mortality and morbidity, health service coverage, and health system resources. Governments rely
on the information provided to them from HIS for the production of high-quality, user- friendly
statistical information on the health status of the community; the use and need of health services;
formulating, monitoring and evaluating health policies; and measuring progress made in the
provision of health services.
HIS can also identify health problems; help to form effective health policies; respond to public
health emergencies; select, implement and evaluate interventions; and allocate resources.
Collecting; analyzing and sharing health information is a complex process that requires a clear
understanding of its underlying components and how these components interact.

Examples of Health Information Systems

Health information systems can be used by everyone in healthcare from patients to clinicians to
public health officials. They collect data and compile it in a way that can be used to make
healthcare decisions.
Examples of health information systems include:
Electronic Medical Record (EMR) and Electronic Health Record (EHR)
These two terms are almost used interchangeably. The electronic medical record replaces the
paper version of a patient’s medical history. The electronic health record includes more health
data, test results, and treatments. It also is designed to share data with other electronic health
records so other healthcare providers can access a patient’s healthcare data.
Practice Management Software
Practice management software helps healthcare providers manage daily operations such as
scheduling and billing. Healthcare providers, from small practices to hospitals, use practice
management systems to automate many of the administrative tasks.
Master Patient Index (MPI)
A master patient index connects separate patient records across databases. The index has a record
for each patient that is registered at a healthcare organization and indexes all other records for
that patient. MPIs are used to reduce duplicate patient records and inaccurate patient information
that can lead to claim denials.
Patient Portals
Patient portals allow patients to access their personal health data such as appointment
information, medications and lab results over an internet connection. Some patient portals allow
active communication with their physicians, prescription refill requests, and the ability to
schedule appointments.
Remote Patient Monitoring (RPM)
Also known as telehealth, remote patient monitoring allows medical sensors to send patient data
to healthcare professionals. It frequently monitors blood glucose levels and blood pressure for
patients with chronic conditions. The data is used to detect medical events that require
intervention and can possibly become part of a larger population health study.
Clinical Decision Support (CDS)
Clinical decision support systems analyze data from various clinical and administrative systems
to help healthcare providers make clinical decisions. The data can help prepare diagnoses or
predict medical events — such as drug interactions. These tools filter data and information to
help clinicians care for individual patients.

Components of Health information system

The Health Metrics Network’s “Framework and Standards for Country Health Information
Systems” describes the six components of a health information system and the standards needed
for each. There is clear value in defining what constitutes a health information system and how
its components interact with one another to produce better information for better decisions and
better health. In addition to its six components, a health information system can be further
divided into its inputs, processes, and outputs. There is clear value in defining what
Inputs refer to resources; processes touch on how constitutes a health information
indicators and data sources are selected and data are system and how its components
interact with one another to produce
collected and managed. Outputs deal with the better information for better decisions
production, dissemination, and use of information. and better health.
Accordingly, the six components of a health
information system are as follows:
Inputs

1. Health information system resources: These consist of the legislative, regulatory, and
planning frameworks required to ensure a fully functioning health information system,
and the resources that are prerequisites for such a system to be functional. Such resources
involve personnel, financing, logistics support, information and communications
technology (ICT), and coordinating mechanisms within and among the six components.

Processes

2. Indicators: A core set of indicators and related targets for the three domains of health
information is the basis for a plan and strategy for a health information system. Indicators
need to encompass determinants of health; health system inputs, outputs, and outcomes;
and health status.
3. Data sources: can be divided into two main categories: (1) population-based approaches
(censuses, civil registration, and population surveys) and (2) institution-based data
(individual records, service records, and resource records). It describes a basic set of
standards for each source and strategic elements in achieving these standards. A number
of other data-collection approaches and sources—occasional health surveys, research,
and information produced by community based organizations—do not fit neatly into
either of the two main categories but can provide important information that may not be
available elsewhere
4. Data management: This covers all aspects of data handling: collection, storage, quality-
assurance, flow, processing, compilation, and analysis. Specific requirements for
periodicity and timeliness are defined where critical—as in the case of disease
surveillance.

Outputs

5. Information products: Data must be transformed into information that will become the
basis for evidence and knowledge to shape health action.
 6 Dissemination and use: The value of health information can be enhanced by making it
readily accessible to decision makers (giving due attention to behavioral and
organizational constraints) and by providing incentives for information use.

For a health information system to function,

For a health information system to
policy, administrative, organizational, and
function, policy, administrative,
financial prerequisites must be in place. Supportive organizational, and financial
legislative and regulatory environments are needed prerequisites must be in place.
to enable confidentiality, security, ownership,
sharing, retention, and destruction of data.
Investment from domestic and international
sources is required to strengthen ICT and provide human resources to run these systems.
Expertise and leadership at national and subnational levels must also be provided to enable the
monitoring of data quality and use. And infrastructure and policies must be in place to transfer
information between producers and users both inside and outside the health system.

Limited national resources and capacities may affect the capacity of countries to apply the
standards that the HMN framework proposes. Where standards are not in place, they are likely to
evolve over time as countries adapt, use, and learn from the HMN framework.
 Figure 1. Representation of the components and standards of a health Information System
HIS are part of the wider statistical system, which covers non-health sectors such as education
and employment. Most traditional HIS collect data at a granular level by various means such as
surveys, clinical observation, diagnostic testing or through management and financial
information systems. They focus on individuals (citizens, patients, health care providers),
characteristics of the services they need, use or deliver, the resources required to deliver those
services and the impacts that they achieve. Those data are then consolidated, analyzed and
reported in various ways to create summary information for use by service providers, managers,
planners, researchers, commentators and others with an interest in the health sector.

Building a health system: The importance of information

HIS are a core building block of a health system. Health information underpins the entire health
system: it strengthens stewardship, can be used in strategic planning and priority-setting, as well
as within clinical diagnosis and management, quality assurance and improvements, and global
epidemics. Healthcare information promotes excellence in care; describes the types of people
using a service and the types of services received; helps coordinate services; provides
meaningful information on the health status of the community; and ensures accountability. A
core value of the Health Metrics Network is that better health information will lead to better
decision making, and as such, better health. Decision makers, for example, cannot identify
problems and needs, track progress, evaluate the impact of interventions or make evidence-based
decisions when they lack information.

Data are becoming increasingly required to track performance, monitor progress and evaluate the
effectiveness, efficiency and impact of health services. Data are also driving more healthcare
decisions, and many initiatives have been established to use data in monitoring performance
improvement efforts, improving outcomes, and comparatively as benchmarks. The elevated
importance of data in health is reflected in the growing number of organizations and publications
dedicated to the topic

While there is general agreement that improved health outcomes need strong health systems,
much of the data and information produced from HIS, ‘remain unprocessed, or, if processed,
unanalyzed, or, if analyzed, not read, or, if read, not used or acted upon’. That is, as well as
having their own issues, HIS are also affected by issues related to their core building block: data.

Raw data alone are rarely useful; they must be converted into credible and compelling evidence;
compiled, managed and analyzed to produce information; integrated; and evaluated in terms of
issues confronting the health system. Data require an organized set of processes and procedures
for this flow of collecting, collating, analyzing and communicating: they need a fully functioning
HIS. It should not come as a surprise that many developing countries struggle with this complex
task and have become what many refer to as ‘data-rich but information-poor’. The issue of too
much data and not enough information is not restricted to the health sector.

Issues and challenges associated with HIS

Despite global interest and investment in health outcomes, and the ‘statistics maelstrom’ this has
produced, little is reliably known on the mortality or incidence and duration of disease in many
developing countries. It is still a struggle, for example, to answer simple questions such as ‘who
dies from what’ for most of the world’s population. While a basic building block of HIS is
counting births and deaths, the stark reality remains that, ‘most people are born and die
uncounted, the reasons behind their deaths unknown’. Due to historical, social and economic
forces, most HIS are complex, fragmented and unresponsive to users’ needs. Furthermore,
chronic under-investment in systems for data collection, analysis, dissemination and use mean
that few developing countries have strong and effective HIS to monitor the health status of their
populations or progress towards internationally agreed outcomes such as the Millennium
Development Goals.

Many HIS have technical inefficiency: they lack centralized databases, standardized processes
and quality assurance procedures. The statistical data skills and capacity of human resources are
often overlooked, especially in developing countries, with staff poorly paid and undervalued.
Ministries of Health often do not manage large components of their HIS and authority over data
collection is out of their control. HIS in countries where global health investments are directed
are usually weak and fragmented by disease-focused data requirements, leaving them
overwhelmed by multiple, parallel information demands and overburdened by excessive
reporting requirements. Many developing countries are also driven by historical norms, donor
interests and lobbying pressures, with little incentives or capacity to collect, share, analyses and
interpret local data.

There is also a noticeable lack of evidence regarding HIS due to the limited role information
systems play in research priorities, with current knowledge on the topic referred to as ‘ad-hoc,
disjointed, and an unsystematic collection of facts, figures and points-of-view’. HIS are
historically a neglected field, and underinvestment continues to be the root cause of many
weaknesses. There remains a large disconnect between the need for information and a country’s
ability to respond. This tension between country needs and global demands raises many
questions around what ‘essential’ information is, and who it is essential for. It also questions how
information can be created and used locally to respond to relevant local needs and demands.

What is needed to strengthen health information systems?

To advocate priorities and strengthen HIS, the following steps are required to support sustainable
change at the national level:

 Country leadership and ownership – to advocate and lead sustainable change

  Responsiveness to country needs and demands – no ‘one size fits all’ approaches
 Building upon existing initiatives – it is important that strengthening strategies are
realistic; recognizing what can be achieved with the available resources and capabilities.
 Supporting gradual and incremental processes with a long-term goal – ensure that
HIS are included in country plans to guide investments and others.

Summary
HIS are integrated efforts to collect data and transform it into useful information for use in
policy, program action and research. Accurate, relevant and timely information on the health
status of communities is essential to public health as it assists in identifying risk factors and the
characteristics of people who use and need health services. HIS play a key role in health system
stewardship, priority setting, clinical management, monitoring global epidemics, and resource
planning. Better data can provide insight into public health problems and guide the development
of policies: both resulting in improved health. However many HIS remain complex and
fragmented due to years of chronic under-investment, with little awareness on the true value of
information in health care. Many countries still do not have reliable information regarding trends
in mortality and morbidity, and while many countries are collecting increasing amounts of data,
there is a lack of appreciation that data alone have no value, as data must be transformed into
information for use. Despite these issues and challenges, there is growing international demand
and attention on improving HIS. This is a positive step forward in the wider recognition of HIS
as an essential component of health system development, and continued work is required to
strengthen HIS to support evidence-based decision-making.
Figure 2.Cyclic representation of transforming data into evidence.

References
1. Health Metrics Network (HMN). 2008. Assessing the National Health Information
System: An Assessment Tool, Version 4.00. World Health Organization: Geneva
2. Abou Zahr C and Commar A. 2008. Neglected Health Systems Research: Health
Information Systems. Alliance for Health Policy and Systems Research: World Health
Organization
3. Health Information Systems Knowledge Hub. 2011. Why are health information systems
important? Issue Brief. Available at www.uq.edu.au/hishub [Accessed 16 January 2012]
4. Ko, E.J., Lee, H.J., & Lee, J.W. (2007). Ontology-based context modeling and reasoning
for u-healthcare, IEICE Transactions on Information and Systems 2007 E90-D(8), 1262-
1270
5.