Health Management Information

System
Midterms – Lesson 5
Health Information System
Traditionally, health care administration has been The health component of HMIS refers to clinical
managed manually, starting from patient studies to understand medical terminologies,
registration to consultation. The creation of clinical procedures, and database processes;
documents proved to be time-consuming and management refers to the principles that help
posed the risk of having duplicate records. administer the health care enterprise; and
Improper storage of these documents was also a information system refers to the ability to analyze
concern because of difficulty in retrieval and the and implement applications for efficient and
high cost of maintaining proper storage. effective transfer of patient information. An HMIS is
one of the six building blocks essential for health
Getting an overview of the number of patients
system strengthening. It is a data collection system
visiting the hospital, or consolidating the nature of
specifically designed to support planning,
problems that need immediate action, and
management, and decision-making in health
providing pertinent reports were difficult to achieve.
facilities and organizations.
Tools such as snapshots and dashboard which are
necessary in the analysis of the performance of HMIS is a set of integrated components and
hospitals were unavailable. procedures organized with the objective of
generating information that will improve health care
Hospitals using the traditional manual process do
management decisions at all levels of the health
not have real-time data and delays in the receipt of
systems. It is a routine monitoring system that
data pose a challenge to evidence-based program
evaluates the process with the intention of
management. Accurate and real-time records of
providing warning signals through the use of
equipment and drugs could not be obtained in a
indicators. At the health unit level, HMIS is used by
timely manner resulting in problems in
the health unit in-charge and the Health Unit
accountability, monitoring of expiry dates, stocks,
Management Committee to plan and coordinate
and auto indenting.
health care services in their catchment area.
Inventory of medicine and equipment was a tedious
HMIS was developed within the framework of the
task due to lack of standards in filing names and
following concepts (Republic of Uganda Ministry of
codes in the institution.
Health Resource Centre, 2010):
The need to enhance the management of health
a. The information collected is relevant to the
care services and to have real-time data to monitor
policies and goals of the health care
the hospital performance thus calls for a health
institution, and to the responsibilities of the
information management system that will address
health professionals at the level of
these concerns.
collection;

Definition b. The information collected is functional as it

is to be used immediately for management
As defined by the World Health Organization and should not wait for feedback from
(2004), health management information system higher levels.
(HMIS) is “specifically designed to assist in the
c. Information collection is integrated for there
management and planning of health programmes,
is one set of forms and no duplication of
as opposed to delivery of care.”
reporting.
 d. The information is collected on a routine 1. Data input includes data acquisition and data
basis from every health unit. verification.
a. Data acquisition refers to the generation and
collection of data through the input of standard
coded formats (e.g., bar codes) to assist in the
faster mechanical reading and capturing of
data.

Roles of HMIS
b. Data verification involves data authentication
The major role of HMIS is to provide quality
information to support decision-making at all levels and validation. The authority, validity, and
reliability of the data sources help ensure quality
of the health care system in any medical institution.
In addition to encouraging the use of health of gathered data.
information in hospitals, it also aims to aid in the 2. Data management, also called processing
setting of performance targets at all levels of health phase, includes data storage, data classification,
service delivery and to assist in assessing data update, and data computation.
performance at all levels of the health sector
(Republic of Uganda Ministry of Health Resource a. Data storage includes preservation and
Centre, 2010). archiving of data. It is advisable that data which are
no longer actively used should be archived. At
An HMIS needs to be complete, consistent, clear, times, it is mandatory and part of legislation.
simple, cost-effective, accessible, and confidential
(Janneh, 2002). b. Data classification is also called data
organization which sets the efficiency of the
It should be complete with all information but system. Key parameters should be used for data
avoiding duplication and consistent in assigning classification schemes for easier data
definitions to similar information from various search.
sources.
c. Data computation requires various forms of
It should also be simple to use and clear as to what data manipulation and data transformation (e.g.,
is measured by the elements. The eligible users mathematical models, linear and nonlinear
must have access and should be able to use the transformation, statistical and probabilistic
system with ease. The confidentiality of patient approaches, and other data analytic processes).
information and data privacy should always be a This function allows data analysis, synthesis, and
top priority. While providing all these benefits, the evaluation so that data can be used not only for
system must prove its cost-effectiveness through its decision-making but also for other tactical and
operations. operational use.
d. Data update facilitates new and changing
Functions of HMIS information and requires constant monitoring. For
The information from an HMIS can be used in HMIS, the mechanism for data maintenance must
planning, epidemic prediction and detection, be in place for updating changes for manual or
designing interventions, monitoring, and resource automated transactions.
allocation (Republic of Uganda Ministry of Health 3. Data output includes data retrieval and data
Resource Centre, 2010). presentation.
Historically, all information systems, including a. Data retrieval pertains to the processes of data
HMIS, are built upon the conceptualization of three transfer and data distribution. The transfer
fundamental information-processing phases: data process considers the duration of transmittal
input, data management, and data output. Each of required data from the source to the appropriate
phase comes with elements (Tan 2010) that end-user. The economics of producing the needed
perform specific functions. information is a significant criterion.
b. Data presentation is the reporting of the provided such as treatment plan and
interpretation of the information produced by the progress note.
system. Summary tables and statistical reports are 9. Financial data refers to information relating
expected but the use of visuals is encouraged to the performance of the entity collected for
especially for high-level managerial decision- administering purposes. These include
making because they provide a better intuitive financial reports, general ledger, payroll,
perspective of the data trend. and accounts payable.

List of Functions of HMIS

Determinants of HMIS
Listed below are the possible functions in an HMIS
with the corresponding type of information that can The determinants affecting the performance of an
be captured and tracked in the system (behavioral HMIS may be behavioral, organizational, and
Health Collaboration Solutions, 2006). technical.
1. Client data relates to all the information of Behavioral determinants
the client which is related to his or her
The data collector and users of the HMIS need to
transactions, reports, and other information
have confidence, motivation, and competence to
such as client billing data, clinical data, and
perform HMIS tasks in order to improve the routine
other client data.
health information system (RHIS) process. The
2. Scheduling is observed to distribute
chance of the task being performed is affected by
resources to areas that need them. An
the individual perceptions on the outcome and the
example is linking the schedule to the billing
complexity of the task (Aqil, Lippeveld, & Hozumi,
of the entity.
2009).
3. Authorization tracking focuses on
monitoring of the authorized personnel and Lack of motivation and enough knowledge on the
their use of the authorized units. use of data has been found to be a major drawback
4. Billing refers to the notification of the in the data quality and information use. Changing
charges for the patient and other related people’s attitude towards data collection and
documents such as the complaint electronic analysis is necessary in order to maximize the
claim. performance of the RHIS process (Routine Health
5. Accounts receivable (A/R) management Information Network, 2003).
ensures that customers are properly notified
about their bill and will settle it accordingly. Organizational determinants
Data for A/R management include tracking The important factors that affect the development of
aging of unpaid services, tracking reasons the RHIS process are the structure of the health
for denials, and aged receivable report by institution, resources, procedures, support services,
payer source. and the culture within the organization (Aqil,
6. Reporting refers to reports issued by the Lippeveld, & Hozumi, 2009). However, other factors
entity which could be basic reports or report which include lack of funds, human resources, and
writer. management support contribute to the determinant
7. Medical record, also called an electronic of the RHIS process.
health record (EHR), is a collection of digital
information about a patient. Aside from Organizational determinants
patient registration, the data could include
Having a system in place which supports data
assessment, treatment plan, and
collection and analysis and transforms it into useful
progress/encounter notes.
information will help in promoting evidence-based
8. Compliance refers to procedure that should
decision-making. Thus, all components within the
be followed for the improvement of the
system are ideal in making the RHIS perform
condition of the patient or the service
better. An improved RHIS performance means an
effective organizational culture that promotes
information use by collecting, analyzing, and using
information to accomplish the organization’s goals
and mission (Sanga, 2015).
Technical determinants
Technical factors involve the overall design used in
the collection of information. It comprises the
complexity of the reporting forms, the procedure set
forward in the collection of data, and the overall
design of the computer software used in the
collection of information (Sanga, 2015).

PRISM Framework
The Performance of Routine Information
Systems Management (PRISM) is conceptual
framework that broadens the analysis of HMIS or
RHIS by including the three determinants of HMIS
performance, namely:
a. Behavioral determinants
- knowledge, skills, attitudes, values, and
motivation of the people who collect and
use data;
b. Organizational/environmental determinants
- information culture, structure, resources,
roles, and responsibilities of the health
system and key contributors at each level;
and
c. Technical determinants
- data collection processes, systems, forms
and methods.
This framework identifies the strengths and
weaknesses in certain areas, as well as the
correlations among these 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, founded on performance
improvement principles, 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 quality data and continuous
use of information, leading to better health system
performance and, consequently, better health
outcomes (Aqil, Lippeveld, & Hozumi, 2009).