Chapter Five

Routine Health Information System

By
Geleta N.(B.Sc., MPH-HI)

May, 2024
Mattu University
Mattu, Ethiopia
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 Lesson Objectives
At the end of this session, students will be able to:

 Describe Routine health information system

 Explain concepts of the Information Cycle

 Explain concepts of Health Management Information Systems.

 Describe the concepts and dimensions of data quality

 Mention data quality checking mechanisms

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 Routine health information systems

 Routine health information systems (RHIS) comprise data

collected at regular intervals at public, private, and community-
level health facilities and institutions and health programs.
 The data give a picture of health status, health services, and health
resources.
 “RHIS is a system that provides specific information support to
the decision-making process at each level of an organization.”
(Hurtubise, 1984).
 Information Cycle

 The Information Cycle is a diagrammatic way of looking at

information.
 It enables you to see the links between the different phases:
collecting, processing, analyzing, presenting, interpreting and using
information.
 Each of these phases has several sub-phases.
Relevant information
Information Cycle
 Data Collection
Why is Data Collection Important?
 Data collection: In this stage, raw data is gathered from various
sources, such as surveys, experiments, observations, or
databases.

o To track changes/stability of health over time

o To evaluate the impact of prevention/health promotion, and

healthcare interventions.

o To monitor resource allocation.

 Data collection tools and
 Selectingmethods
appropriate data collection methods and
validating the tool before using is a crucial point.

 What are the most commonly used data collecting techniques:

o Different types of questionnaire
o Observation
o Measurement
o Experiment/laboratory
o Video /audio Recording
o Different interviews
o Direct collecting/ Data extraction, …
 Standardized Data Collection Tools

 Registers
 Cards/Files retained at the facility
 Cards retained by the client or patient.
 Must include the data required for the HMIS indicators
 These tools capture:
 Medical
 Demographic and
 Financial transaction
 Essentials For Data Instruments
Each of these client/patient recording instruments needs:-
Clear instructions

Continuous supply of these instruments

Easily reported over time and across locations.

Care providers must be trained, using both pre-service

and in-service modalities.

 Standardizing the Data-Collecting Tools

 In standardizing data collecting tools it is important to make the

data collecting tools:
 S- Simple- easy to use (layout)
 O- No Overlap- no duplication of the data elements
 U- Useful for calculating indicators
 R- Relevant for making decisions and plans
 C- Clear- easily understandable (terms used)
 E- Effective in making decisions
 The ultimate objective of health information is not only to ‘gain
information’ but to ‘improve action’.
Factors that affect Data Collection Methods

 Resource (human and financial)

 Ethical issues
 Sensitivity of the information gathered
 Geographic accessibility
 Time
 Language
 Study design
 Type of study participants (E.g. Educational status)
 Quality Control at Facilities

Ensure appropriate administration of the data collection instrument


Monitoring and supervision of facilities is the key to ensuring quality.


Questionnaires should be manually edited before entering data into computer

software.


Correction of errors.


Coding and recoding of questions (if needed).


Checking completeness.


Proper design of the data entry template


The template should reflect the actual Report.
 Quality Check During Data Entry

 Double entry to check consistency.

 Preparing a Data dictionary is mandatory.
 Helps to easily understand the database.
 Data cleaning
 Must be done by a different person.
 Always save the master database on a separate file before
doing any coding and categorizing.
 Sources of data to
HIS has the following data sources :
The healthcare system
 Routine health information
• HMIS/HDIS2
• CHIS
• brushers
• policy briefs
• New letters
 Non-routine health information
• vital registration
• Surveillance
• Research
• Systematic review & analysis
 Data Processing
 Data processing: Once the data is collected, it needs to be
organized, cleaned, and analyzed to extract meaningful insights.
 This may involve statistical analysis, data mining, or other
techniques:-
 To be changed into action data must be processed and analyzed.
 This is the most important part of the information cycle.
 In analyzing data we use the three epidemiologic analytic tools.
 Data Analysis
 Analysis:- Turning data into information

What Is an Information & Information System?

 Information is a meaningful collection of facts/data.

 An information system is a system that provides specific
information support to the decision-making process at each
level of an organization.
 Data Presentation

 The processed data is then presented in a format that is

easy to understand and interpret.

 This could be through tables, charts, graphs, maps, or
other visualizations.
 Reporting and dissemination

 Reporting and dissemination:

o RHIS produces regular reports and dashboards to
communicate key findings to stakeholders, including
policymakers, healthcare providers, researchers, and the
public.
 Information Utilization(use)

 Information utilization: The presented data is used to

generate information that can be applied to make
decisions, solve problems, or gain new knowledge.
 This stage involves interpreting the data and drawing
conclusions.
 Definition and Concepts of HMIS

 HMIS??
Is a system for data capturing, record keeping, processing, analyzing,
interpreting, using, reporting/communicating the routine facility
data, and feedbacking in the healthcare system at all levels.
It is one of the HIS tools, and can be paper based & computerized

The primary aim of HMIS is generating timely quality data to

improve the informed decision makings practices at all levels of
the healthcare system

It is also a vital data source to policy makers, planners, d/t

stakeholders, researchers, academic & non academic
institutions,
 HMIS…..
HMIS is a principal tool to conduct performance evaluation
of health facilities, health programs, and projects …

It is applicable at both public, and private healthcare facilities

It is a primary tool/source to develop various healthcare
indicators
Purposes of HMIS:
• Routine collection & aggregation of quality information
• Availing accurate, timely and complete data
• Provide specific information to support decision making
• Strengthening the use of locally generated data at all
levels
• Accessing data for research, academic, other tasks, etc
 HMIS …
 Why countries need to adopt the HMIS?
o Absence of uniform tool to measure and communicate
o Difficulty of practicing informed decision
o Lack of data timeliness, completeness, accuracy, integrity….
o Lack of data aggregation & use
o Lack of data for planning, resource allocation, performances,
o The need to minimize medical errors & poor health outcomes
o The advancement of Healthcare technologies,
o Questions for service quality,
o Globalization and Environmental competitions,
o Lack of service and measurement standardization,
 Components of HMIS….
HMIS contains the following basic components/tasks
Data
Collection Data
processing

Data analysis

Problem identification

Prioritization & decision

making

Action/Implementation
 HMIS cont’d
The types of reports generated by HMIS
The HMIS is designed to generate d/t types of reports used to
monitor and evaluate health and health programs
We may have d/t mechanisms to group the HMIS
reports:
Mechanisms used to group the HMIS reports
By facility type
Reports by period Reports by content
-Immediately reports - OPD diseases reports - Health post
- Clinic
-Weekly reports - IPD diseases reports
- Health center
- Monthly reports - Service reports - Hospital
- Quarterly reports - PHEM reports - Woreda HO
- Annually reports - Zonal HO
- RHB
 HMIS
cont’d
 Reports generated at each level of the health system need
to submitted to each next subsequent level.
The collection, processing, reporting flow of HMIS
data, Ethiopia
 Assessment of Ethiopian HIS
 Assessment of the existing state of the Ethiopian HIS was done
in March 2007 using the Health Metrics Network (HMN)
framework and tools:-
o According to the assessment results, among the six major
components, three were very weak.
o These were HIS resources, data management, and
dissemination and use rated as “not adequate”.
o HIS resources, policy and planning, as well as HIS
institutions, human resources and finance were rated
inadequate.
 Data Quality
 Form groups, discus, summarize notes, present to class

– What does data quality mean?

– Impacts of poor data quality in terms of healthcare
services, country contribution, etc..
– What are the dimensions of data quality?
 HMIS data quality
 What does a data quality mean?
The status of completeness, accuracy, reliability, relevance,
integrity and timeliness of patient records
Data quality “fitness for use/purpose” is key in a given HIS
Quality of data can directly affect the quality of decision
making in clinical, managerial & policy making
Quality data can determine quality of Healthcare services
It can also determine the communication level
/horizontal/ vertical/internal or external, etc
 Poor data quality
 What are thesymptoms
symptoms of presence of poor data quality?
o If different people supply d/t answers to the same question
o Data are not collected / measured in a standardized
o Less accepted report by staffs , stakeholders, and customers
o Presence of parallel data systems to collect the same indicator
o No documented data management processes
o If data collection & reporting tools are not standardized
o If decisions are not sensible/accepted by the majority
o Mistakes are spotted by external stakeholders (during audits)
o If reports are mismatched with observations, non integrity,
inconsistent, redundancy, and contradicting each other…
 Data quality….
 What are the undesirable outcomes of poor quality data?
‾ Having in appropriate information
‾ Garbage in Garbage out conditions
‾ Erroneous decision makings (clinical & managerial)
‾ Poor resource utilization
‾ Delivery of services with poor quality
‾ Poor client satisfaction
‾ Lack of acceptance from staffs, stakeholders &
customers
‾ Difficulty of identifying facility successes & failures
‾ Poor health coverage and community health status
‾ Pseudo effectiveness & efficiency of health facilities
‾ Less competent health facilities
 Data quality…
 What are the desirable outcomes of good data quality?

• Good quality data

• Right information
• Appropriate decision making
• Improved service quality

• Very good client satisfaction

• Increased service utilization
• Better effectiveness & efficiency of facilities
• Improved Community health status
• Competent & profitable health facility
 Data quality….
 What is data quality assurance?
• A systematic and frequent M & E of data to discover
discrepancies in the data & data management system, and making
necessary corrections to ensure data quality
 What are the data quality dimensions?

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 Data quality dimensions…
Dimensions Descriptions
- Data what they are intended to be measured
Accuracy/ - Documentation reflects an event as it actually happened
valid/ reality
- Eg. Date of admission must be same as or earlier than date of discharge
- Yielding the same results on repeated collection,
Reliability/
measurement, processing, presenting,…
Consistency/
-Eg. ICD Dx on Pt form should be the same with Dx written on
precision
OPD abstract register
- Data containing all the required elements on registers, forms/cards
- Data/report completeness: data contain all report elements
- Comprehensiveness: data/report included reports of all departments/ units
- Completeness of data (%) = # values entered (not missing) in the report
# Total data elements in the report
Completeness
- Completeness of reports (%) = # of reports received in a given period
# Total reports expected
- Comprehensive/Inclusiveness (%) = # unit/department reports received
# Total unit/department reports expected

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 Data quality dimensions…
Dimensions Descriptions
- Data/information/report must be received within the specified period
- The data should be up to date/ very recent for use
Timeliness - Timeliness (%) = # reports submitted or received on
time
# total reports expected
- Delayed data is a waste = considered as not sent
report
- All data whether written, transcribed and/or printed should be readable
Legibility - Unclear data are less usable & decisions may be less acceptable
- Clarity of data highly determines value & usability of data
- All necessary data are available when needed at all time & levels
Accessibility - The value of quality data becomes valueless if not accessed on time
- Data should be accessible to the legal users with right formats at all times

- Data is integrate if the identity/ content & quality/ is not altered / same at
Integrity its source and communicated places = same before & after communication 64
 Data quality
….

o Data is relevant to decision making if it is quality

o The Right information to the Right person at the

Right time with the Right/appropriate/ format is
crucial to scale up informed decision making
at all levels of HS
 Data quality…..

We may evaluate the quality of information as follows:

Appropriateness: Does the information relate to the work and
objectives of the organization?

Quality: Does the collected data fulfil data quality dimensions?

Timeliness: Is the information up to dated and accessed on time?

Quantity: Is the information available sufficient to do
appropriate conclusions ?
 Data quality…
 Factors that may affect data quality
• Poor data management KAP
• Lack of data management guidelines
• Absence of data management inputs resources
• Using non-standardized data collection and reporting formats
• Unclarity/non-user friendliness of data collecting& reporting
tools
• Limited staffs’ training data collecting & reporting formats
• Less attention/supports from staffs & healthcare managers
• No/poor M & E , and feedback on HIS and data quality
 Data quality assurance techniques

Although there d/t techniques, we are practicing the

following common one:
1. Lot Quality Assurance Sampling (LQAS)
2. Routine Data Quality assessment (RDQA)
 Lot Quality Assurance Sampling
(LQAS)
o Is a technique useful for assessing whether the desired level
of data accuracy/consistency has been achieved by comparing
data in relevant record forms (i.e. registers or tallies) and the
HMIS reports.

Description:
o The data compiled in databases and/or reporting forms
Versus what is in registers at the facility level.
o Similarly, when data is entered in the computers, data on
reporting forms versus computer files.
 Lot Quality Assurance Sampling Cont’d…
 It is a method for testing the hypothesis of whether data quality is
achieved or not.
 It uses a sample size of 12 data elements and tries to check the
reporting accuracy.
 If the number of sampled data elements not meeting the standard
exceeds a pre-determined criterion (decision rule), then the lot is
rejected.
 Decision rule table is used for determining whether the pre-set
criterion is met or not.
 Comparison of LQAS results over time can indicate the level of
o Who: Health facilities will maintain a registry to record the data
consistency check results and to look at the trend of the data
quality improvement.
o What: pick the aggregated serial number for those having
detailed data element (eg FP new acceptors are considered as
two data elements having by age & sex aggregation)
o Frequency: Monthly
o This is a method for testing hypotheses related to the level of
HMIS data quality whether it is achieved or not.
 The Decision Rule

• IS a slide on LQAS Table for sample size of 12 used to know

for deciding whether we have achieved the desired level of data
quality or not.
Decision Rules for sample Sizes of 12 and Coverage Targets /Average of 20-95%
Average Coverage (baselines)/Annual Coverage Targets (monitoring and
Evaluations)
Less
Sample than 20 25 30 35 45 55 60 65 70 75 80 85 90 95
size 20% % % % % 40% % % % % % % % % % %
12 N/A 1 1 2 2 3 4 5 6 7 7 8 8 9 10 11

o What actions would be necessary if the data

accuracy/ consistency at a health facility is not of
the desired level (90%).
 Desk review

Visual Scanning (Eye Balling)

• It is a simple method used at the health facility
to check for consistency of reports before/after
conducting data entry

• The PMT members sit together and look across

each line and then from top to bottom to
identify:
o missing data values,
o unexpected fluctuations beyond maximum/ minimum
values,
o inconsistencies between linked data elements, and
 Visual scanning
Examples:
• Family planning acceptors by age and method disaggregation
• Antenatal first attendance by gestational and
age disaggregation
• Delivery attended by skilled health personnel vs Sum of
still birth and live birth
• Inconsistencies of data elements/indicators over time
• Comparison of performance across health facility

• Frequency: any time

 Routine Data Quality Assessment (RDQA)
o A tool helps to perform data accuracy/consistency at the
administrative level by enabling quantitative comparison of
recounted data to reported data
o A tool helps to perform data accuracy/consistency at the
administrative level by enabling quantitative comparison of
recounted data to reported data
• It is a simpler version of the DQA
• RDQA is self-assessment & usually done prior to DQA
• The RDQA tool should be applied regularly to monitor the trend in
data quality.
• It is recommended to be implemented quarterly by the
administrative health unit
 Components of RDQA
RDQA tool has two key components
1. Data Verification: facilitates a quantitative comparison of
recounted to reported data a review of the timeliness,
completeness and availability of reports.
2. System assessment: enables qualitative assessment of the
elative strengths &weaknesses of functional areas of a data
management and reporting system.
A report data consistency
Indicators Description HF1 HF 2 HF3 HF4 HF5 HF6 HF7 ∑A / ∑B VF= A/B

ANC4 Recounted=A 10 50 70 20 30 40 20 240 0.89

Reported=B 12 65 70 20 25 45 30 267
SBA Recounted =A 111 44 2 20 10 9 15 211 0.93
Reported=B 121 43 0 12 25 9 15 225
Penta 3 Recounted=A 25 45 30 12 20 10 0 142 0.83
Reported=B 38 59 30 16 15 13 0 171
Currently Recounted=A 10 22 10 5 40 19 20 126 1.94
on ART
Reported=B 0 12 4 5 32 12 0 65
Meseals Recounted=A 20 55 34 14 45 25 27 220 0.79
Reported=B 12 42 23 22 95 36 47 277
TB all Recounted=A 41 71 29 78 9 1 12 241 1.14
forms
Reported=B 29 36 34 80 6 10 17 212
Data Verification decision rule

System assessment
• M&E Capabilities, Roles and Responsibilities
• Training
• Data Reporting Requirements
• Indicator Definitions
• Data-collection and Reporting Forms and Tools
• Data Management Processes
• Data Quality Mechanisms and Controls
 Information is Power!

 No life without valid information!

 If you have quality information, no one will win you in a
legal environment!
 Quality information makes owners competent every where

 If you have quality information, you can shake the Glob!

 Hence, plan & work to have adequate quality information!!!