RATIONALISING HEALTH INFORMATION SYSTEMS TO IMPROVE HEALTH OUTCOMES

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RATIONALISING HEALTH INFORMATION SYSTEMS TO
IMPROVE HEALTH OUTCOMES Public Health
Services Queensland Health Australia 1998-2000
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Dr Magnolia Cardona Coordinating
EpidemiologistMB.BS, MPH, Grad DAE, CHEcon
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Objectives of this lecture

• Provide an overview of information system types
  and potential uses
• Increase awareness on need to balance amount of
  data with cost and confidentiality concerns
• Present case scenarios to set up and enhance
  information systems

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Characteristics of Good Health Surveillance
Systems

• Clear objectives
• administration
• routine documentation
• monitoring
• research/evaluation
• Simple (MDS)
• Standard item format
• Justification and validation of items

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Characteristics of Good Health Surveillance
Systems (cont)

• Relevant to users
• Minimum burden to providers
• Amenable to modification
• Provision for security/confidentiality
• Associated reporting system
• Feedback to collectors
• Linked to action

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Options

• Paper-based centralised
• Sentinel/selected surveillance
• Computerised stand alone
• Single site
• Multicentre

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Options

• Computerised networked
• Encrypted data transfer
• Combination
• Paper-based notifications
• electronic entry at central location

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Setting up a Health Information System Which
option is best?
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SCENARIO Cholera epidemic in Africa

• No routine surveillance
• Poorly kept clinical records
• Understaffed facilities
• Unreliable communications
• No ongoing funding
• No computers

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Cholera epidemic in Africa
Example of a paper-based system that worked in an
endemic area for at least 2 years
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Occupational exposure to bloodborne illnesses
among health staff

• Hundreds of health facilities
• Infrequent incidents
• Non-compulsory recording
• No ongoing funding
• Confidentiality issues
• Compensation issues

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Nutritional Status Monitoring in
a remote indigenous community

• Routine surveillance of some conditions
• Somehow comprehensive clinical records
• Services staffed by community
• Unreliable communications
• Some funding available
• Some computers usable

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Major stakeholders concerns

• How the data will be collected
• How the data will be used
• Who will have access to the data
• Confidentiality issues
• Perceived discrimination
• Financial implications

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Indigenous Community Health

• Computerised system
• Easy front-end
• Complete patient information (alias/residence)
• Promotes opportunistic P.H. action
• Capability for health worker plans
• Population based reporting system
• Generates customised prevalence/incidence

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Burden of depression at Medical Practitioners
rooms

• Non-standard recording practices
• ? Availability of clinical records
• Busy medical practices
• Variable communication systems
• Low computer coverage
• Ethical issues
• Incentives required for doctors

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Doctors-based Sentinel Surveillance

• Enables documentation of non-hospital data
• Burden of disease measurement
• Paper-based with weekly notifications
• Limited patient information conditions
• Selected Locations (self-selected doctors)
• Inability to calculate prevalence/incidence

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Example of project to maximise efficiency of
existing health information systems

• Real case scenario

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Improve health outcomes through enhancement of
Public Health information systems
Aim
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Objectives

• High quality /timely data
• Minimise duplication/cost
• Standard coding practices
• Common table structures
• Common operating environment
• Shared hardware
• Data Linkage

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Inventory of Databases

• Purpose/Scope /Contents
• Size/Accessibility
• Operating system/server/interface
• Data tables
• Remote access/re-development
• Special requirements
• Staff involved

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Integration Protocols

• Hardware /software
• Data definitions NHDD
• Reference tables
• Data Entry Transfer
• Security /Confidentiality

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Working Group

• Discuss IT requirements
• Re/development experience
• Security Principles
• Sharing of reference tables
• Integration protocols
• Recommendations

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Levels
Integration
Business
User interface
Data use (structure)
Database (execute instructions)
Platforms (hardware)
Network (WAN, LAN)
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BSR
PSR
Lead
NOCs
VIVAS
MODDs
Business
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Interface
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Data use
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Database
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Platforms
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Network
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How does this improve Health Outcomes?

• Outbreak response/timing
• Immunisation rates
• Prescription control
• Standard Indigenous identifiers
• Early cancer detection\QA

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Summary

• Relevance cost-effectiveness
• Consultation with users and data holders
• Financial considerations
• Ethical implications
• Ultimate goal to improve health