Introduction

Healthcare administrations were managed manually, traditionally starting from

then patient registration to consultation. The creation of documents proved to
be time consuming and posted a risk of having duplicate records. There was
also a need for proper storage, which, if not considered and practiced, could
result to difficulty in retrieval and high cost maintenance.
Getting an overview of the number of patients visiting the hospital, or the
nature of problems that needed immediate action, or even providing pertinent
reports was very difficult to achieve. There are neither snapshots nor a
dashboard view, which isan important tool in the analysis of the performance
of the hospitals.
Accurate and real-time records for equipment and drugs could not be obtained
in a timely manner using the traditional process, giving rise to the challenges
such as accountability, monitoring of expiry dates, stocks and auto indenting.
In a nutshell, the problems faced by hospitals using the traditional manual
process included:

 No real time data available to monitor the performance of the hospital

 Evidence based program management was a challenge
 Undue delays in receipt of data
 Retrieval of old manual records was ineffective and time consuming.
 Duplication of records
 Monthly reports sent as hard copy which is a real challenge for data
analysis/comparison
 Drug inventory/equipment inventory maintenance.
 Lack of standard names and code

To address the aforementioned issues, using a Health Management

Information System (HMIS) should be taken into account. This will address
the need to enhance the management of the healthcare services and to have
a real time data availability to monitor the hospital performance.

Define concept, role, and function of HMIS

6.1.1. HMIS defined
As defined by the World Health Organization (2004), a Health
Management Information System (HMIS) is an information system specially
designed to assist in the management and planning of health programs, as
opposed to delivery of care.
An HMIS is one of the six building blocks essential for health system
strengthening. It is a data collection system specifically designed to support
planning, management, and decision making in health facilities and
organizations.

Figure 6.1: Health Management Information System

The system is actually a set of integrated components and
procedures organized with the objective of generating information which will
improve health care management decisions at all levels of the health system.
It is a routine-monitoring system that monitors and evaluates the process with
the intention of providing warning signals through the use of indicators.
At the health Unit level, HMIS is used by the health unit in-charge
and the Health Unit Management Committee to plan and coordinate health
care services in their catchment area.
6.1.2 Roles of the HMIS
The major role of HMIS is to provide quality information to support
decision-making at all levels of the health care system in any medical
institution.
In addition to encouraging the use of Health Information in the
hospitals, it also aims to aid in the setting of performance targets at all levels
of health service delivery and to assist in assessing performance at all levels
of the Health Sector (Ministry of Health, 2010).
A Health Management Information System needs to be:
Complete

 It should provide information on all key aspects of the health system

without duplication

Consistent

 If similar information is provided by different sources, their definitions

need to be consistent.

Clear

 It should be very clear what all the elements are actually measuring

Simple

 It should not be unnecessarily complicated

Cost Effective

 The actual usage of each element should justify the costs of its
collection and analysis.

Accessible

 Data should be held in a form readily accessible to all legitimate users,

and it should be clear who these people are.

Confidential

 It should ensure that people without legitimate access are effectively

denied.

Source:Extracted from the speech of Saihou Janneh, Director of Planning

and Information for the Department of State for Health, 2002 HMIS Policy
Retreat.
6.1.3. Functions of HMIS

Figure 6.2: Basic Functions of the HMIS

The information from the HMIS can be used in planning, epidemic prediction
and detection, designing interventions, monitoring and resource allocation
(Ministry of Health, 2010).
Historically, all information systems, including HMIS, are built upon the
conceptualization of three fundamental information-processing phases: data
input, data management, and data output.

1. Data Input - includes data acquisition and data verification.

2. Data Management – also called processing phase includes data
storage, data classification, data update, and data computation.
3. Data Output - includes data retrieval and data presentation.

Eight Elements of the HMIS

Tan (2010) enumerated the following elements of a Health Management
Information System:
1. Data Acquisition
This involves both the generation and the collection of accurate, timely,
and relevant data. In HMIS, this is normally achieved through the input
of standard coded formats (e.g., the use of bar codes) to facilitate the
rapid mechanical reading and capturing of data.
2. Data Verification
Data verification involves the authentication and validation of gathered
data. The quality of collected data depends largely on the authority,
validity, and reliability of the data sources.
3. Data Storage
The preservation and archival of data may be regarded as part of the
data storage function. When accumulated data are no longer actively
used in the system, a method to archive the data for a certain period is
usually advisable and may sometimes be mandatory, as when it is
required by legislation.
4. Data Classification
This is also known as Data Organization. It is a critical function for
increasing the efficiency of the system when the need arises to conduct
a data search. Most data classification schemes are based on the use
of certain key parameters. For example, data referring to a patient
population may be classified and sorted according to various diagnostic
classification schemes.
5. Data Computation
Data computation involves various forms of data manipulation and data
transformation, such as the use of mathematical models, statistical and
probabilistic approaches, linear and nonlinear transformation, and other
data analytic processes. It allows further data analysis, synthesis, and
evaluation so that data can be used for strategic decision-making
purposes other than tactical and/or operational use.
6. Data Update
New and changing information is accounted for through the element of
data update. The dynamic nature of such data modification calls for
constant monitoring. For HMIS to maintain current data, mechanisms
must be put in place for updating changes in the face of any ongoing
manual or automated transactions.
7. Data Retrieval
Data retrieval is concerned with the processes of data transfer and data
distribution. The data transfer process is constrained by the time it takes
to transmit the required data from the source to the appropriate end-
user. One significant criterion to be considered in the data retrieval
function is the economics of producing the needed information.
 8. Data Presentation
Data presentation has to do with how users interpret the information
produced by the system. In situations where only operational or even
tactical managerial decision making is expected, summary tables and
statistical reports may suffice. The use of presentation graphics for
higher-level managerial decision analysis is particularly encouraged
because these appear to provide a better intuitive feel of data trend.

List of functions of HMIS

Listed are the range of possible data and functions that may be
available in the system, and it represents the type of information that can be
captured and tracked in HMIS along with its corresponding functionality, as
discussed by the Behavioral Health Collaboration Solutions (2006).

Table 6.1: Functions in the HMIS

 Determinants of HMIS Performance Area

The determinants which affect the HMIS performance may be Behavioral,

Organizational and Technical.

Figure 6.3:Determinants of the HMIS

6.2.1. Behavioral determinants
The data collector and users of the HMIS need to have confidence,
motivation and competence to perform HMIS tasks in order to improve the
Routine Health Information System (RHIS) process. The chance of the task
being performed is affected by the individual perceptions on the outcome of
what is being performed and the complexity of the task being performed (Aqil,
Lippeveld, and Hozumi, 2009).
Lack of enough knowledge on the use of data has been found to be
a major drawback on the data quality and information use. Motivating HMIS
users remains a challenge. Despite training on data collection and data
analysis, people are still having negative attitude on the data, and hence a lot
needs to be done to change people’s behaviour, in order to increase the
performance of the (RHIS) process (Routine Health Information Network,
2003).
6.2.2. Organizational determinant

Figure 6.4: Sample Organizational Determinants of the HMIS

Health workers and data collectors work in organization's
environments which have value, norms, culture and practice. The most
important organizational factor which affects the RHIS process is related to
structure, resource, procedure, support services and the culture which is used
to develop and improve the RHIS process. (2000, Design and Implementation
of Health Information Systems. Geneva: Sage.Lippeveld T)
However, there are other factors which affect the RHIS process
which includes lack of funds, human resource, and management support.
Having a system in place which support data collection, analysis and
transform it to useful information will help in promoting evidence based
decision making. Thus all components within the system are ideal in making
the RHIS perform better.
The effectiveness of the organizational culture is to improve RHIS
performance, promoting a culture of information use, which involves the ability
and control to promote values and beliefs among members of an organization
by collecting, analyzing and using information to accomplish the organization's
goals and mission (Sanga, 2015).
6.2.3. Technical determinants
Technical factors involve the overall design used in the collection of the
information. It comprises the complexity of the reporting forms, the procedure
set forward in the collection of data, the overall design of the computer
software used in the collection of information (Sanga, 2015).

Figure 6.5: Technical Determinants

6.3. PRISM Framework
Known as Performance of Routine Information System Management (PRISM),
this conceptual framework broadens the analysis of routine health information
systems to include the three key factors which were discussed previously:

 Behavioral determinants—knowledge, skills, attitudes, values, and

motivation of the people who collect and use data.
 Technical determinants — data collection processes, systems, forms,
and methods.
 Organizational/environmental determinants—Information culture,
structure, resources, roles, and responsibilities of the health system and
key contributors at each level.
Figure 6.6: PRISM Conceptual Framework
This framework identifies the strengths and weaknesses in certain
areas, as well as correlations among areas. This assessment aids in
designing and prioritizing interventions to improve RHIS performance—which
in turn improves the performance of the health system.
The PRISM Framework defines the various components of the
routine health information system and their linkages to produce better quality
data and continuous use of information, leading to better health system
performance and, consequently, better health outcomes. It is founded on
performance improvement principles (Aqil, Lippeveld, and Hozumi, 2009).
Figure 6.7: Technical and Organizational Factors in the PRISM Framework

KEY POINTS TO REMEMBER

 HMIS is an information system specially designed to assist in the

management and planning of health programs, as opposed to delivery
of care.
 The major role of HMIS is to provide quality information to support
decision-making at all levels of the health care system in any medical
institution.
 Historically, all information systems, including HMIS, are built upon the
conceptualization of three fundamental information-processing phases:
data input, data management, and data output. The eight (8) elements
include: Data Acquisition, Data Verification, Data Storage, Data
Classification, Data Computation, Data update, Data retrieval and Data
presentation.
 The determinants which affects the HMIS performance; it starts by
describing the Behavioral, Organizational and technical determinants,
and its related components.
 PRISM Framework defines the various components of the routine health
information system and their linkages to produce better quality data and
continuous use of information, leading to better health system
performance and, consequently, better health outcomes.