HEALTH MANAGEMENT INFORMATION

SYSTEM (HMIS)

PREPARED BY:JRPRMT
 INTENDED LEARNING
OUTCOMES
At the end of this unit, the learner will be able to;
1.Define HMIS
2.Describe deficits of HMIS in Ethiopia
3.List elements of HMIS
4.Explain indicators of HMIS
5.Discus the steps of developing HMIS

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Basic concepts
System: A collection of components that work together to
achieve a common objective
Health System: All the activities whose primary purpose is to
promote, restore or maintain health.
Information: Meaningful collection of facts or data.
Information System: A system that provides information support
to the decision-making process at each level of an organization

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Basic concepts…
Health Information System: A system that integrates data
collection, processing, reporting, and use of the information
necessary for improving health service effectiveness and
efficiency through better management at all levels of health
services
Management information system: A formal method of making
available accurate and timely information to management that is
necessary to facilitate the decision- making process and enable
the organizations planning, control and operational functions to
be carried out effectively.

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Basic concepts…
Health Management Information System: It is
an application of the principles of management
information system in health care systems. Or an
information system specially designed to assist in
the management and planning of health
programmes, as opposed to delivery of care

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Why health information system?
•Good management is a prerequisite for increasing
the efficiency of health services.
•Improved health information system is clearly linked
to good management.
•Information is crucial at all management levels of
the health services from periphery to the center.
•The system provides information on past, present
and projected future & relevant events inside and
outside the organization.
Why health information system?...
•It is required by policymakers, managers,
health care providers, community health
workers.
•Changing the way information is gathered,
processed, and used for decision-making
implies changing the way an organization
operates.
Why health information system?...
•With the widespread computerization of health
records and other information sources,
including hospital administration
functions and health human resources
information, health informatics and health
information technology are being increasingly
utilized in information management practices in
the health care sector.
Health information management
professionals
•Plan information systems, develop health policy,
and identify current and future information needs.
•Apply the science of informatics to the collection,
storage, use, and transmission of information to
meet the legal, professional, ethical and
administrative records-keeping requirements of
health care delivery.
•Work with clinical, epidemiological, demographic,
financial, reference, and coded healthcare data.
Evolution
In the past, mostly informal.
Present, electronic data processing (EDP) –
use of computers in information management
(computer based information system).
Now called MIS.
HMIS in developing countries
Information system procedures were not intentionally
planned to provide management support in an integrated
way
Too much emphasis was given (placed) on the
measurement of impacts which called for costly
assessment
Many decisions on policy, planning and resource
allocation are made without analysis of the information
that is readily available
The data received are often incomplete, inaccurate,
untimely, obsolete, and unrelated to priority tasks and
functions of the local health personnel

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HMIS in Ethiopia
The RHBs are primary institutions responsible for
the health service delivery.
Capacity for effective health management at all
levels remains to be low.
There is major concern regarding the HMIS.
Timeliness and completeness of the system
reporting are among the major weaknesses of the
system.
Progresses are also observed in some regions.
HMIS in Ethiopia…
The RHB of SNNP has developed reporting
formats and a reference guideline for health
workers in the region with collaboration
between the RHB, Regional government, and
the ESHE/JST project funded by USAID.
This guideline consists of standard data
collection formats, standard information
presentation instruments; such as charts and
tables to be followed by the health workers and
other pertinent information on the subject.

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HMIS in Ethiopia…
The Tigray RHB has also conducted similar
efforts.
Initiatives are also under process to prepare
National Management Health Information
System Strategy by the Planning and
Programming Department (PPD) of the FMOH
(PPD, 2003).

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Deficiencies of HMIS in Ethiopia
Considering the problems experienced by
many developing countries, the HMIS in
Ethiopia seems not to be different from other
developing countries.
Preliminary assessment of NHMIS and
experiences of some regions (SNNR); the
current HMIS showed that it has the following
major deficiencies.

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Deficiencies of HMIS in Ethiopia…
In general, the current HMIS is inadequate in
providing the required information for
management support.
Hence, data coming from the system is not a
resourceful input for decision making.
There is considerable underutilization of the
information generated by the system for
decision making at all levels specially in the front
line where the data is collected and information is
generated.

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Factors attributed to deficient HMIS in
Ethiopia
The data quality is considered to be very poor
Outputs of HMIS are not related to the priority tasks
and functions of the local health personnel
Lack of technical knowledge and skill of data
collectors at the lower level
Lack of uniformity and consistency in definitions.
Outdated ICD
Considerable limitation of financial and material
resources

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What is wrong with current HMIS?
•Irrelevance of the information gathered
•Poor quality of data
•Duplication and waste among parallel health information
system
•Lack of timely reporting and feedback
•Poor use of information
•The difference in culture between data people and
decision makers: Planning and management staff rely
primarily on “gut feeling” to formulate ad hoc decisions
rather seek pertinent data.
(WHO 2000, Regional Office for Africa, 2004).
Constraints with current HMIS
•Limited funding
•Deficiency in information infrastructure
•The network is still vulnerable to external shock
caused by virus, repair and /or replacement delays,
difficult system codes etc.
•Significant underutilization of data / information for
decision making
•Lack of interest or / and experience of use of
information by managers
•Inadequate human resource, lack of expertise
What’s the HMIS objective?
Ensuring the quality of all health data.
Strengthening the ability to analyze and use
the data.
Making informed and cohesive decisions can
and will positively affect the health and lives of
the people.
Planning, organizing, leading, controlling and
decision-making.
 Elements of HMIS
Training standards Organization rules
Software design Data collection standards
Procurement/ Distribution Case definitions
Quality assurance Data transmission
Private sector Confidentiality
Factors to evaluate information received
1. Information quality – accuracy and reliability.
2. Information timeliness – before deviations
occur.
3. Information quantity – Just sufficient.
4. Information relevance – related tasks and
responsibilities.
Design of HMIS
•Desired characteristics of information in health
services
Relevance
Accuracy
Completeness
Timeliness
Conciseness
Sources of Information System
oHealth institutions (inpatient/outpatient and
other activities)
•Vital registration systems (births, deaths, and
migratory movements)
oLaboratories and pharmaceuticals
oCommunity
Sources of Information System…
oCensus
oSpecial programmes reporting systems
(tuberculosis and leprosy control, MCH, school
health)
oAdministrative systems (health care financing
systems, health personnel systems, logistic
systems)
Sources of Information System…
oInvestigation of outbreaks
– Surveys and surveillances
– Diseases notifications
– Routine reports

Which of the above sources are computerized?

Each source has its own advantages and

limitations.
A framework for defining information
needs and indicators
Perform a functional analysis at each
management level of the health service
system.
Identify information needs and select feasible
indicators
Indicators are variables that help to measure
changes, directly or indirectly (WHO).
A framework for defining information
needs and indicators…
Indicators are important to:
◦ To analyze present situation
◦ To make comparisons
◦ To measure trends

Most health indicators are quantitative

(numbers)
Helpful questions in selecting good
indicators
•What is the indicator supposed to measure
(validity)?
•What will be the cost of measuring the data to
arrive at the numerator and denominator of the
indicator?
•Is the change shown by the indicator a true
change in the situation under study.
Helpful questions in selecting good
indicators…
What is the relative importance of the subject
matter to be addressed and the decision to be
made based on the indicator (relevance)?
Does the indicator actually capture the
changes that occur in the situation under study
(specificity)?
Types of Indicators
Health policy
Social and Economic Development Indicators
Population changes
Provision of health care
Health Status (nutritional, morbidity, mortality)

Information is collected, analyzed, presented

and communicated.
Steps in Developing a HMIS
(1) Review the existing system
(2) Define the data needs of relevant units
within the health system
(3) Determine the most appropriate and
effective data flow
(4) Design the data collection and reporting
tools
(5) Develop the procedures and mechanisms
for data processing
Steps in Developing a HMIS…
(6) Develop and implement a training
programme for data providers and data users
(7) Pre-test, and if necessary, redesign the
system for data collection, data flow, data
processing and data utilization
(8) Monitor and evaluate the system
(9) Develop effective data dissemination and
feedback mechanisms
(10) Enhance the HMIS
 Steps involved in restructuring of HMIS
Step 1: Identifying information needs and feasible indicators
Step 2: Defining data sources and developing data collection
instruments for each of the indicators selected
Step 3: Developing a data transmission and processing system
Steps involved in restructuring of HMIS…
Step 4: Ensuring use of the information
generated
Step 5: Planning for HMIS resources
Step 6: Developing a set of organizational rules
for health information system management
(WHO, 2000)
Key issues of HMIS
Movement of data through out the system
Accessibility and analyzability of data
Transmission of finding to potential users
Tasks of HMIS
Filing and storing
Compiling
Analyzing
Types of reports
Operational: detailed
Technical: mentoring and evaluation
Strategic: to justify priorities and decisions
Managing the flow of data
◦ Impose strict timetable at each level.
◦ Ensure two-way flow.
◦ Establish regular cycle of analysis and feedback.
Data collection instruments
1. Data collection instruments for patient/ client
management
A. Curative
• Medical records
• Laboratory forms
• Referral forms
Data collection instruments…
B. Preventive
• Growth cards
• MCH cards
• School health card
• Family registration records
Data collection instruments…
2. Data collection instruments for health unit
management
A. Service delivery records.
– Registers
– Tally sheets (Abstract register
– Population charts

B. Resource Management records

Strategies for MIS Development
Plan carefully for modification of existing
system establishing new.
Change attitudes to information gathering
processing and utilization.
Participate staff in HMIS.
Provide training for utilizing HIS
 Computer applications in health service
delivery

1. Clinical information systems

2. Administrative information systems
Computer applications in health service
delivery…
How to decide on need for a computer?
o Technical feasibility
o Operational feasibility
o Economic feasibility
Computer applications in health service
delivery…
How to introduce micro computers
o Choose software
o Choose computer
o Assess the physical environment
o Assess the organizational environment
Computer applications in health service
delivery…
o Train personnel to use computers
o Social behavior
o Training for managers
o Training for problem solving
o Define role of computer in work environment