Lesson 4: Overview of health informatics
Health Information Technology (HIT)
•involves development & management of health
information for improved health service delivery
•Rouse 2016: the area of IT involving the design,
development, use of IS for health care industry
• focuses on tools
Health informatics
• is the application of both technology & systems in
a health care setting
•Health Information Technology & HIM
HEALTH CARE SOFTWARE SYSTEMS
Types of HIT:
1. Electronic Health Record (EHR) / Electronic
medical record (EMR)
• patient’s official health record in digital form , then
shared to health care providers/agencies
2. Personal Health Records (PHR)
• person’s self-maintained health record
3. Health Information Exchange (HIE)
• health data clearinghouse to share data to HITS
US HITECH Act of 2009
• use of HER increased
• EHR criteria is regulated under the office of the
national coordinator ONC for health IT
• Medicare Access & Children’s Health insurance
plan reauthorization act MACRA law on value-
based reimbursement system passed by US 2015
Two types of HIT:
1. Picture Archiving & Communication Systems
PACS
2. Vendor Neutral Archives VNA: merging stored
imaging data from depts. into a multi-facility
•Help manage, store patient’s medical images
•Integrate radiology into the main hospital workflow
Radiology- used to be primary repository for
medical images
Cardiology, neurology- for clinical images
HEALTH INFORMATION ECOSYSTEM
Health Interoperability Ecosystem
• composition of individuals that share, exchange,
access of discrete, narrative, multimedia infos
• Potential stakeholders: providers, researchers
within such an ecosystem
• secure capture, seamless, discovery, exchange of
health information
HEALTH INFORMATICS IN THE CLOUD
• 83% of health care are making use of cloud-
based app and its changing the landscape
• both benefits and threats exits (University of
Illinois 2014)
Advantages of Cloud Technology
1. Integrated & Efficient Patient Care: offers a
single access point for patient info
2. Better Management of Data
Disadvantages
1. Potential Risks to Personal Information
2. Cloud Setup Seems Cumbersome
HEALTH INFORMATICS IN THE PHILIPPINES
• Since 1980s, IBM (international business
machines corporation)
Community Health Information Tracking System
(CHITS)
• Linux, Apache, MySQL, PHP-based system under
GPL was named finalist at the Stockholm challenge
2006 & top 3 e-gov projects in Phil by APEC ADOC
• CHITS is an Electronic medical record for health
centers in disadvantages areas in 111 facilities
• lack of interest in the field
• seen as a novelty rather than as a profession
• many decision makers do not use the benefits of
information technology in health sector
• large initial expenditure (Marcelo, 2012)
Lesson 5: Health information system DATA SOURCES FOR HIS DAHHPCO
Donaldson & Lohr 1994
Health Information System
• Systems that capture, storage, transmit health 1. Demographic data- facts
infos sourced from individuals/ activities of health
institutions 2. Administrative data- services information,
• Improves delivery of health services ensures file procedures, practitioner, physician’s specialty,
access, better control, easier update, improved institution, charges, payments
communications 3. Health Risk information- lifestyle & behavior,
• should be user friendly, sustainable, economical family history, propensity
ROLE & FUNCTION OF HIS 4. Health status- quality of life that a patients leads
Sheahan 2017: it is a mechanism keeps track all which is crucial to is health (physical, mental,
data
emotional, cognitive)
1. Easier Access to Files
2. Better Control 5. Patient medical history- (hospital admissions)
3. Easier Update
4. Improved Communications 6. Current medical management- diagnoses,
allergies, medications, screening sessions, lab test
COMPONENTS OF HIS (HIDDID)
Health Metrics Network HMN 2008 7. Outcomes data- after effects of health care,
health care events, readmission, side effects
1. HIS resources
planning, regulation (personnel, ICT)

2. Indicators
health system inputs, outputs, outcomes, status

3. Data Sources
A. Population-Based Approaches
civil reg, census, surveys
B. Institution-Based Data
individual records, community-based
Resource Records System- FinancialMIS,
LogisticsMIS, Infras&equipmentMIS
Health Facility Surveys- supervisory,
readiness, quality of care

4. Data Management: collection to data analysis

5. Information Products: evidence and insight to

shaping health action

6. Dissemination and use

Can be categorized by:

1. Inputs- HIS resources
2. Process
Indicators, Data Sources, Data Management
3. Outputs
Information Products, Dissemination & Use
Lesson 6: Health Management Information System
Health Management Information System (HMIS)
WHO 2004: specially designed to assist in the
management & planning of health programs
Health- clinical studies to understand medical terms
Management- principle that help administer health
care enterprise
Information system- ability to analyze app for
efficient transfer of info
HMIS FRAMEWORK
(Uganda Ministry Health Resource Centre 2010)
1. Relevant to policies & goals
2. Functional as to be used immediately
3. Integrated for one set of forms
4. Collected on a routine basis
ROLE OF HMIS
• Major role: provide quality info for decision making
at all levels of the health care system (Patient,
Health Unit, Health System)
• It must be: Complete, Consistent, Clear, Simple,
Cost-Effective, Confidential (Janneh, 2002)
FUNCTIONS OF HMIS (Tan 2010)
1. Data input VA
data acquisition (bar codes) & verification
DETERMINANTS OF HMIS PERFORMANCE
AREA
1. Behavioral Determinants
(Aqil, Lippeveld, Hozumi 2009) confidence,
motivation & competence, individual perception
2. Organizational Determinants
culture, institution, resources, procedures,
3. Technical Determinants
overall design used in collection, reporting forms,
collection of data, overall design computer software
PRISM FRAMEWORK
Performance of Routine Information Systems
Management
• It broadens analysis of HMIS or RHIS
determinants:
1. Behavioral Determinants- knowledge, skills,
attitudes, value, motivation
2. Organizational / Environmental Determinants –
info culture, resources, roles, responsibilities
3. Technical Determinants- data collection process,
systems, forms, methods

2. Data management CCUS

data storage, classification, computation, update

3. Data output RP
data retrieval & presentation

LIST OF FUNCTIONS OF HMIS

(Behavioral Health Collaboration Solutions 2006)
1. Client data- billing, clinical data
2. Scheduling- distribute resources
3. Authorization tracking- monitoring of personnel
4. Billing- notification of the charges
5. Accounts Receivable management- settle bill
6. Reporting- basic reports or report writer
7. Medical record- EHR, treatment plan, progress
8. Compliance- follow up
9. Financial data- general ledger, payroll
Lesson 7: HMIS Monitoring & Evaluation HMIS INDICATORS AND HEALTH PROGRAMS

Monitoring & Evaluation HMIS –source of routine data necessary for

– core component of current efforts to scale up for monitoring different aspects of various health
better health programs

Monitoring Maternal survival interventions

collection, analysis, and use of info gathered from • 5th millennium development goal targets to reduce
programs for learning, accounting resources used maternal mortality by 75% & universal access;
both internal & external, for decision making cannot be alone
• Campbell & Graham 2006: packaging of health
Evaluation facility-orientated interventions is highly effective
systematic assessment of completed programs or
policies HMIS Indicators:
1. Pregnancy Care Interventions
PURPOSE OF M&E: to assess the effect of an 2. Intrapartum Care
integrated service delivery 3. Post-Partum Care
4. Interpartum Period
M&E FRAMEWORK
of Health System strengthening HSS & from Paris Child Mortality & Child Survival Interventions
declaration • Under 5 in Phil 2012: Pneumonia (2,051),
Four components: Diarrhea, Gastroenteritis, Congenital Anomalies,
1. Indicator domain Nervous System, Etc.
2. Data collection DOH STRATEGIES TO ENSURE CHILDREN BY
3. Analysis and synthesis 2025
4. Communication use 1. Child 21
PNSFPDC 2000 to 2025 safeguarding welfare of
M&E PLAN (National Health Mission Of India)
Strategies for Successful M&E: Filipino children & commit to UNCRC
1. Be localized 2. Children’s health 2025
2. Address needs for multiple users & purposes sub of child 2, utilizing the life cycle approach
3. Facilitate the id of indicators & data sources
4. Be able to use M&E in disease programs 3. Integrated Management of Childhood Illness
(IMCI)
M&E AND HMIS INDICATORS lower child mortality caused by common illness
Indicator: measures the value of the change in 4. Enhanced Child Growth
units that can be compared to past & future units operating community-based health & nutrition posts
HMIS KEY INDICATORS (USAID US Agency for Stop TB Program
International Development) •Reduce TB by 2015 & achieve universal access to
high-quality care including those with HIV & drug
1. Reproductive Health resistant TB
2. Resource Utilization
3. Disease Prevention & Control HMIS Indicators:
4. Data Quality 1. TB patients on DOTS (smear-positive tb)
5. Immunization 2. TB case detection (+-new detected)
3. HIV-TB co infection (new TB)
4. HIV+NEW TB (patients in DOTS)
5. TB treatment outcome (completed, cured,
defaulted, deaths PTB+)
Lesson 8: HMIS Data Quality
Data Quality
• Overall utility of a data base as a function of its
ability to be processed easily & analyzed for a
database, data warehouse
data’s appropriateness
Data Cleansing
• Raise the quality available data (rouse 2005)
follows after the complete profiling of data concerns
Lot Quality Assurance Sampling (LQAS)
• Tool that allows use of small random samples to
distinguish bet different groups of data elements
(Lots) with high and low quality
Steps:
1. Define service (DQA of DHIS)
2. Identify unit of interest (facility, hospital, district)
3. Define higher and lower threshold
4. Determine the level of acceptance error to
declare “below expectations”
5. Identify the number of errors (mismatched data if
performing above or below expectations)
Routine Data Quality Assessment (RDQA)
• Tool that is simplified version of Data Quality
Audit (tool which allows programs & projects to
verify & assess the quality of data)
OBJECTIVES:
1. Verify rapidly
2. Implement corrective measures
3. Monitor capacity improvements
USES:
1. On-going supervision
2. Initial & follow up assessment
3. Strength program M&E
4. Preparation for DQA
5. External assessment
Development Implementation Plan
• Project management tool that illustrates how a
project is expected to progress at a high level
Key Steps:
Define goals Schedule Milestone
Allocate sources Define metrics for success
Designate team member responsibilities
DATA QUALITY TOOLS
• Analyzes information & identifies incomplete data
USED: (Gartner 2017) PPGEMM
1. Parsing & Standardization- decomposition
2. Generalized Cleansing- modification
3. Matching- merging
4. Profiling- analysis of data
5. Monitoring- deployment of controls
6. Enrichment- enhancement
SCOPE OF DATA QUALITY TOOLS
• 1st generation- data cleansing for reduplication
• Last 10 years- Extract, Transform, Load (ETL) of
alimentation process
• Recently- Data quality Management for profiling
ROOT CAUSE ANALYSIS
• Problem solving method that identifies root cause
of problems instead of simply addressing obvious
symptoms; improve health care and ask why 5
times (Bowen 2011)
1. Failure Mode & Effects Analysis (FMEA)
used when there is new products, changes,
updates & problem is reported thru feedback
What is the mode? How many times?
What actions? Effective?
2. Pareto Analysis
20% of work creates 80% of results
when there are multiple potential causes
by excel software, bar graph (causes)
line graph (collective percentage)
should be 80% of involved
3. Fault Tree Analysis
used in risk and safety analysis; uses Boolean logic
undesirable is at the top, causes are below
4. Current Reality Tree
used when root causes of multiple problems need
to be analyzed ALL AT ONCE
5. Fishbone/Ishikawa/Cause & Effect Diagram
categorized causes & sub-causes of problem
Categories: 4Ms manufacturing, 4S 8Ps service
People, Equipment, Procedure, Environment
6. Kepner Tregoe Technique
assessing situation using priorities & orders of
concern for issues; decisions are outlined
7. Rapid Problem Resolution (RPR Problem
diagnosis)
diagnose causes in recurrent problems
1. Discover- data gathering
2. Investigate- plan
3. Fix- monitoring
INFORMATION CULTURE
• Determined by mission, history, industry, culture,
traits; shaped by cognitive expectations
Lesson 9: Hospital Information System
Hospital Information System
• Computer system that could manage all infos to
permit providers do their job efficiently & 1960s
billing, inventory & Today financial, scientific, admin
must be affordable, scalable, on needs, optimized
core library
DEPARTMENTS:
1. Nursing IS- patient charting app
2. Physician IS- 24/7 EHR, EMR
3. Radiology IS- billing, scheduling
4. Pharmacy IS (PIS)- drug interactions
SELECTING A HIS:
1. Total Cost Of Package- Budget
2. Web-Based System- Anywhere, Anytime
3. Implementation & Support- training
HIS PROVIDERS IN THE PHIL
1. Bizbox
25 years ago; hospital project 1994; top IT
companies; independent software vendor ISV of
the year
2. KCCI Medsys
Kaiser dela cruz consulting, inc.
MEDSCHO for school
3. Comlogik
phil based in 1999, to be global tech company
online services: billing, reports, records
HIS FUNCTIONS:
1. Help Desk, Scheduling, Patient Registration
2. Admission, Discharge, Transfer
• Out/Move Hospital: not allowed dead & w/o
permission & emergency: fill the statutory require
3. Billing, Contract Management, Package Deal
Designer
Goodrich 2013: reducing financial risk & Success
contract management: financial returns, responsive
of supplier, no contract surprises, satisfactory
• For emergencies- “Post- Diagnostic Package
Deal”
REPORTING
Laboratory Reporting
• with administrative info: name, id #, lab name &
address, report date, test date, doctor
specimen & test info: specimen source, date time,
lab #, test results, abno, critical, units of measure,
reference ranges, interpretation, condition of
specimen, deviations, medications
Radiology Reporting
• physician authorized by HC inst. Interprets
admin info, patient id, history, observations, etc.
Cardiology Reporting
• set against past medical records
using CIS vascular sonography reports are created
MATERIALS MANAGEMENT SYSTEM-
PHARMACY, MAIN STORES, AND PURCHASE
Materials Management
• Distributing, etc materials; guarantee sufficient
materials in right location when needed
• utilize barcodes and RFID tags (Pontius 2018)
Management Reporting
• not limited to data retrieval , for controlling
information VALUABLE to the institution
• help in capturing data sets that needed for
managers to run effective enterprise
• employee headcount, customer acc information,
funding, performance
• offer a single holistic view highlights high value
sources Kumar 2017
In-Built Tally Interface
Tally.ERP99
• provides simplified solutions to operations
(registration, accounting, inventory, tax)
Lesson 10: Laboratory Information Management
System
Laboratory Information Management System
• a software designed to make lab more efficient &
effective; used in LIS in med & pharmaceutical
• Gartner’s 2016: hype cycle of life sciences- for
biobanks & genomic testing
REQUIREMENTS & FEATURES OF LIMS
1. Sample Management
• by Radio-Frequency Identification/Barcodes
who, what, provider, handled, where, how, when
2. Workflow Management
• automate records and workflow & preset rules
3. Reporting
• handling time, instrument, backlogs list
4. EHR
• patient records &billing info
5. Mobile
• limited but better
6. ERP (Enterprise Resource Planning)
• view current supplies, storage capacity, location
CORE COMPONENTS OF LIMS (BEW SCRAPE)
1. Best practice
2. ERP software
3. Workflow tools
4. Sample management programs
5. Client Tracking applications
6. Records management software
7. App to interface with analytical instruments
8. Process execution software
9. Electronic Laboratory notebooks
LABORATORY STANDARDS
• Occupational Exposure to Chemicals Hazards in
Laboratory Standard- US by Occupational Safety &
Health Administration OSHA 2011
1. In laboratory scale
2. Use of multiple chem
3. Procedures should not stimulate any production
process
4. Protective tools, proper training
5. Hazardous: chem used for maintenance,
commercial, testing of product
Chemical Hygiene Plan
• proper purchase, storage, handling, disposal of
chemicals
Primary Elements:
1. Establishment of SOP standard operating
procedure
2. Monitoring of the work environment
3. Statement of plan of how to obtain free medical
care
4. Designation of personnel
LIMS APPLICATION
1. Patient Registration – by admission clerks
2.Billing
3. Contract management
• customer customizable invoices, electronic
formats for invoices, customizable info completion,
managerial reports, change insurance org, select
tests covered by insurance, supervision of financial
data, reminder for amounts due from past visits
4. Account receivables
• generate complete AR reports & monitor balances
export data to other account system & customize
reports
WORKLIST & WORKFLOW
• to facilitate more efficient laboratory processes
allows user to track samples, plan workload
schedules
QUALITY CONTROL (QC)
• QC result-verify whether instrument is working in
prescribed parameters the reliability of Patient
Results will be determined
• QC result can be quantitative, qualitative
(negative/positive), semi-quantitative (limited)
• for Quality assurance
Barcode-Generation, Printing, and Reading
• Barcoding Label Generator- easy method
• Barcode Editor- print multiple
In-Built Bi-Directional Interfaces w/ Equipment
• Saves time in programming test orders
• 2-way communication between Information
System & Clinical Instrument is required
• also used in microbiology, hematology
• random access feature & barcode label scanning
Lesson 11: Other Hospital Information System
Cardiology Information System
• storage & retrieval of cardiology-centric images
receives an order
• profiled based on the order & stored for further
distribution, viewing, & long-term archiving
(Katipula & Ireland, 2013)
EVOLUTION OF CIS:
•1970 originated from mainframe environments,
whose technical specifics would considered
ridiculous
•1980 modular systems that emphasized the use of
real-time applications & mini computers became
the trend •then the INTERNET > creating networks
& facilitating integration
•REMOTE ACCESS & EASY RETRIEVAL
BENEFITS OF CIS:
1. Ease Of Access While Maintaining Data Security
• eliminating doctors to request different imaging
results from different departments
Radiology Information System
• network system used in managing imagery &
associated data
• useful or tracking radiology imaging orders &
billing
PACS- storage & management of medical images
VNA- to manage image archives & for record-
keeping
• EASIER ACCESS with EHR > better patient
experience
• Faster processing of payments; permits report
FUNCTIONS OF RIS:
1. Patient Management
• tracks entire workflow; add images, generate
reports to EHRs for easy retrieval
2. Scheduling
• appointments of in & out patients
3. Patient Tracking
• patient’s radiology history from admission to
discharge

2. Flexibility In The Workflow 4. Results Reporting

• assess a wide array of information • statistical reports

3. Enhanced Comparability 5. Image Tracking

• CIS is an essential repository of cardiology • RIS track films & assoc. data & cover the entire
imagery results • retrieval of past data is convenient clinical workflow of medical enterprise

FUNCTIONS OF CIS: 6. Billing

1. Editing, Viewing And Storing Multi-Modal • record keeping & Electronic Payments
Cardiology Data
• computed tomography, cardiac ultrasound
(echocardiography), magnetic resonance imaging
(MRI), nuclear imaging (PET & SPECT),
angiography may be managed on a single platform

2. Remote Access
• use of networks & integrated info systems,
coupled with the availability of the internet &
tablets, smart phones offers flexibility to CIS

3. Visualization & Reporting Capabilities

• 2 main benefits: EASE & CONSISTENCY OF
REPORTING; result: real-time info retrieval

4. EHR Integration
• enhancement of QUALITY SERVICE of health
professionals offers more comprehensive view