Improving Hospital Information Systems

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Improving Hospital Information Systems

• Or accommodating the complexities of the
  environment

Vincent Shaw, Health Information Systems
Programme SA
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Aim

• Discuss some of the weaknesses in our Hospital
  Information Systems
• Explore why we have these problems
• Suggest mechanisms for overcoming the weaknesses
• Within a context /environment of uncertainty and
  change
• types of diseases
• types of services
• staff turnover

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Information Needs in Hospitals
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Focus of this presentation
Patient demographics
Admission
Separation
Final Diagnostic information
Clinical information QIC
Radiographic information
Laboratory information
Pharmaceutical information
Traditional information needs of clinicians
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Information Needs in Hospitals

• Essential Data Set

• Through-put information
• Admissions
• Discharges/deaths
• In-patient days
• Out-patient attendances
• Deliveries, etc

• Indicators
• Occupancy rates
• ALOS
• Case fatality rates

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Overview of presentation

• What are the components of an information system
• Who collects what, how and how is it processed
  and used?
• Implications for Hospital IS design

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Why are Routine Hosp IS important?

• Managers must have accurate data on the workload
  in their hospital
• Needed for resource allocation within the
  hospital, and also between hospitals
• Human resources (staff)
• Equipment
• Financial resources

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The components of an information system

• Who collects information
• What information is collected
• How is the information collected?
• How is the information processed and used

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Are all the units in the Organisational Hierarchy
submitting data?

Province Parent OrgUnit of the hospitals
Province
Hospital


Ward or OP Dept


Hospital Parent OrgUnit of
the reporting units
Reporting OrgUnit
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Shortfall in delivery data 2002, ECP

• Implications of the reporting gap in maternity
  data?
• If a simple process, such as deliveries, are not
  accurately recorded, what are the gaps in other
  areas that are more complicated?
• Incomplete and inaccurate data used for planning

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Who collects information at the stages in the
process of dealing with patients?
Patient in OPD for admission
Admitted in ward
Processes
Discharged
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Patient for admission from ANC clinic
Patient for admission - ? In labour
Antenatal care ward
Assessed in labour ward
Home
In labour
Not in labour
Delivery
Babies
Babies mothers
Babies mothers
Postnatal care ward
Nursery care
Kangaroo mother care
Home
Home
Home
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Screened by nurse
Doctor assesses
Patient
Outcome
Nurses record the interaction

• Who collects the information
• Can we develop systems that doctors can use which
  can serve their purposes and those of the nurses
  and managers?

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Summary Who collects information

• Are all our reporting units included?
• Have we thought strategically about the points at
  which information is captured?
• Can we bring together the teams to co-ordinate
  data capture for one another?

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The components of an information system

• Who collects information
• What information is collected
• How is the information collected?
• How is the information processed and used

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What information is collected?
The information hierarchy
Total deliveries Deliveries mothers under
18 Deliveries mothers over 18 Deliveries under
2500g Deliveries over 2500g
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What information is collected?

• We are focussed on throughput information, and
  ignoring information for quality of care issues.
• Difficulties in initiating processes of getting
  the team together round the table
• Lack of skills in being able to facilitate this
  process
• Dont forget the use of surveys
• Not all information needs to be submitted in the
  same intervals (daily, weekly, monthly,
  quarterly)

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The components of an information system

• Who collects information
• What information is collected
• How is the information collected?
• How is the information processed and used

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The components of an information system

• Who collects information
• What information is collected
• How is the information collected?
• How is the information processed and used

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How is information collected collated?
Record of patients seen
Summary of key information
Data analysis and use
Feedback
Data entry into database
Data processing
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How is the information processed?
What is the essential information that is needed
from each domain?
This is dependant on The capacity of the
organisation to be able to document the
information The degree of sophistication of the
information system
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Accommodating paper-based and electronic
information systems
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Considering the levels of computerisation within
the hierarchy
Is the computerisation at Some, but not all
levels? For some but not all data e.g.
Throughput information vs Quality
Improvement data?
Computerisation level
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Considering the levels of computerisation within
the hierarchy
Is the computerisation at The hospital
level? The reporting unit level?
Computerisation level
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The balancing act between paper-based and
electronic systems
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Interplay between the components of an
information system
Volume of data
Technical capacity
Human resource capacity
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DHIS as a Management Tool
Extracts of data from specialist systems
Routine data
District Health Information Software as
Integrated Information System
Survey data
HR data
Financial data
Data from QI programmes
EPR data
Copy of data from PHC services
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Care 2X www.care2x.org

• Developed by a team of developers across the
  world
• Adopted by many countries as the OS for their
  hospitals
• PHP programming language, Windows and Linux,
  MySQL database

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Use of EPR systemsGo the Open Source Systems
route

• Why
• Proprietary systems are expensive
• Rigid and serve narrow needs (billing)
• Create dependancy on suppliers
• A different philosophy is needed
• FOSS provides a forum whereby different people
  can contribute to the development of the
  software, and others can freely benefit from that
  use
• Creates and environment where experimentation and
  innovation is encouraged
• Potentially addresses the needs of many users

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Summary How is information collected and
collated?

• Accommodate both paper and electronic systems
• Flexibility built into our systems to accommodate
  changes over time
• Changes in information needs
• Changes in access to communication technology
• EPR/Billing systems are disappointingly
  inaccurate because of
• Lack of access to systems
• Inflexible systems

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Interplay between the components of an
information system
Volume of data

• Human resource capacity
• Numbers of staff, turnover
• Hospital information officer
• Technical competency in use of computers, in data
  collection, and in processing and presenting
  information
• Competency to analyse and interpret information

Technical capacity
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Implications for Routine Hospital IS

• Facilitate the development of IS over time
• Develop sustainable mechanisms for providing
  support
• Systems need to be designed so that they can
  accommodate change

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Facilitate the development of IS over time

• Encourage the incremental growth of IS depending
  on HR capacity and technical capacity
• Develop capacity in hospitals to process and
  utilise information
• PHC had a huge input in terms IS, but hospitals
  have had very little to date
• Focus on the quality of data for the throughput
  information
• See HIS as systems that are intricately linked to
  QoC issues move beyond the throughput
  information only

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Develop sustainable mechanisms for providing
support

• HR training through a partnership between
  government and academia
• Information systems in general
• Technical aspects of the IS
• Use of information for improving service delivery
• Accommodate the high turnover of staff in the
  public sector
• Use of FOSS software

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Design systems that they can accommodate change

• Information needs change over time
• Type of information (HIV/AIDS)
• Degree of detail (Birth weight of babies)
• Types of services provided may change
• Volume of information
• Access to technology will also continue to grow
  exponentially
• Staff capacity changes in the context of a high
  staff turnover