Presentation on Health information system for the students of the course "Public health informatics" in MPH program in NIPSOM under BSMMU

1. Health information
management system
Dr. Protik Kumar Banik
MBBS, MPH (Epidemiology)
Lecturer
Department of Epidemiology
National Institute of Preventive & Social Medicine
(NIPSOM)

2. Learning objectives
At the end of the session the participants will be able
to learn about
Health information management system (HIMS
or HIS)
Functions of HIS
Examples of HIS
Benefits of HIS
HIS in Bangladesh

3. Health Information Management System
An information system consisting of computer
hardware and software, procedures, and processes
that are specifically designed and implemented to
store, maintain, collect, process, represent, and
manage information specific to the health care
domain.

4. HIS
Health information systems also include those
systems that handle data related to the activities of
providers and health organizations.
As an integrated effort, these may be leveraged to.
improve patient outcomes, inform research, and
influence policy-making and decision-making.
Because health information systems commonly
access, process, or maintain large volumes of
sensitive data, security is a primary concern.

5. HIS- Function
The American Health Information Management
Association (AHIMA) singles out five functional areas
covered by the HIS.
•

6. HIS- Function
• Data capture, validation, and maintenance calls
for the introduction of policies and procedures to
get reliable data. This results in fewer claim denials,
decreased operational costs, improved patient
safety, and better research outcomes.
• The stage involves activities related to data quality
management, data integration, support
for healthcare data standards, and optimum
information flow design.

7. HIS- Function
• Data analysis, transformation, and decision
support
revolve around deriving knowledge and insights
critical for enhancing patient care.
• Information dissemination and liaison
are about effective sharing of health records,
reports, and research findings.

8. HIS- Function
• Health information resource management and
innovation
take care of health documents across their life
cycle.
• Health information governance and
stewardship
ensure compliance of data use with regulations,
standards, ethical norms, and internal
organizational policies.

9. HIS- Function
HIM practices are applicable wherever health
information exists, from private physician’s offices to
large hospital chains.
But for ultimate clarity, we need to answer the
question:
What exactly is health information?

10. Health information vs health data
Elements like “120/80 blood pressure,” “20 years,”
“10/12/21,” and “ John Snow” are just pieces of data.
But a resulting record detailing “On October 12,
2021, the blood pressure of 20-year-old John Snow
was 120/80” is information that supports patient care
and brings value to both healthcare providers and
patients.

11. Health information vs health data
The specific thing about HI is that more often than
not it comes codified. The use of free text to capture
diagnoses, procedures, drug data, and other
important details can lead to varying interpretations
that may disrupt efficient treatment and proper
insurance reimbursement.

12. Medical codes
HI heavily relies on healthcare terminology
standards or codes, representing core medical
concepts. The industry-specific vocabularies help
avoid miscommunications and ambiguity in records.

14. Medical codes
Among the most widespread coding systems are
• ICD-10-CM (the International Classification of Disease,
Clinical Modification)
for documenting injuries and diagnoses, specifically in
medical claims;
• CPT (the Current Procedure Terminology)
and HCPS (Healthcare Common Procedure Coding
System)
for reporting all types of healthcare services, both
inpatient and outpatient;
• CDT (Code on Dental Procedures and Nomenclature)
for documenting dental treatment;

15. Medical codes
• SNOMED CT (Systematized Nomenclature of
Medicine – Clinical Terms)
for capturing symptoms, clinical findings, family
history, medical services, drugs, and other aspects
related to the course of treatment;
• LOINC (the Logical Observation Identifiers Names
and Codes)
for recording lab orders/ results and vital signs;
• NDC (National Drug Codes) for pharmacy
products;
• RxNorm for drug classes.

16. Examples of Health Information Systems
Health information systems can be used by everyone
in healthcare from patients to clinicians to public
health officials..
Examples of health information systems include:
1. Electronic Medical Record (EMR) or Electronic
Health Record (EHR)
2. Practice Management Software
3. Master Patient Index (MPI)
4. Patient Portals
5. Remote Patient Monitoring (RPM)
6. Clinical Decision Support (CDS)

17. Electronic Medical Record (EMR) or
Electronic Health Record (EHR)
These two terms are almost used interchangeably.
The electronic medical record replaces the paper
version of a patient’s medical history.
The electronic health record includes more health
data, test results, and treatments. It also is designed
to share data with other electronic health records so
other healthcare providers can access a patient’s
healthcare data

18. Electronic Medical Record (EMR) or
Electronic Health Record (EHR)
The cornerstone of switching to the patient side of
things, electronic health records (EHR) focus on the
documentation and storage of a patient’s medical
information.
In the past, clinicians had to document everything on
paper, by hand — now, they can simply fill out that
information on their computer or mobile device.

19. Electronic Medical Record (EMR) or
Electronic Health Record (EHR)
EMR started as a way to eliminate the time and
errors that came with the manual charting of patient
data.
The problem, historically, with EMRs was that patient
information was only able to be viewed within one
office — so, if a patient switched to a different
hospital, their medical information would not follow
suit.
EHRs eliminate this shortcoming by allowing the
transfer of patient data among different health care
facilities..

20. Practice Management Software
Practice management software helps healthcare
providers manage daily operations such as
scheduling and billing.
Healthcare providers, from small practices to
hospitals, use practice management systems to
automate many of the administrative tasks.

21. Master patient index
A master patient index (MPI) connects separate
patient records across databases.
The index has a record for each patient that is
registered at a healthcare organization and indexes
all other records for that patient.
MPIs are used to reduce duplicate patient
records and inaccurate patient information that can
lead to claim denials.

22. Patient Portals
Patient portals allow patients to access their personal
health data such as appointment information,
medications and lab results over an internet
connection.
Some patient portals allow active communication
with their physicians, prescription refill requests, and
the ability to schedule appointments

23. Remote Patient Monitoring (RPM)
Also known as telehealth, remote patient
monitoring allows medical sensors to send patient
data to healthcare professionals.
It frequently monitors blood glucose levels and blood
pressure for patients with chronic conditions. The
data is used to detect medical events that require
intervention and can possibly become part of a larger
population health study.

24. Clinical Decision Support (CDS)
Clinical decision support systems analyze data from
various clinical and administrative systems to help
healthcare providers make clinical decisions.
The data can help prepare diagnoses or predict
medical events — such as drug interactions. These
tools filter data and information to help clinicians care
for individual patients.

25. Benefits of Health Information Systems
Health information systems tend to target efficiency
and data management. The main drivers of health
information systems are:
• Data analytics:
The healthcare industry constantly produces
data. Health information systems help gather,
compile and analyze health data to help manage
population health and reduce healthcare costs. Then
the healthcare data analysis can improve patient
care.

26. Benefits of Health Information Systems
• Collaborative care:
Patients often need to treatments from different
healthcare providers. Health information systems —
such as health information exchanges (HIEs) —
allow healthcare facilities to access common health
records.

27. Benefits of Health Information Systems
• Cost control:
Using digital networks to exchange healthcare data
creates efficiencies and cost savings. When regional
markets use health information exchanges to share
data, healthcare providers see reduced costs. On a
smaller scale, hospitals aim for the same efficiencies
with electronic health records.

28. Benefits of Health Information Systems
• Population health management:
Health information systems can aggregate patient
data, analyze it and identify trends in
populations. The technology also works in reverse.
Clinical decision support systems can use big data to
help diagnose individual patients and treat them.

29. Best Practices for Health Information Systems
Security is the primary health information system
concern. The Health Insurance Portability and
Accountability Act (HIPAA) regulates the protection of
individual healthcare information. To help keep systems
secure companies should:
• Train employees
• Encrypt data
• Back up data
• Monitor usage
• Buy insurance
• Access vendor vulnerability
• Utilize multifactor authentication

30. Best Practices for Health Information Systems
• Besides security, it’s useful to focus on patients.
Use health information systems to increase
convenience and access for patients.
• Remember the clinical staff is probably the best
resource for health information system decisions.
• Involve clinicians in deciding how health information
systems can be used and which technologies will
be best.

31. DHIS - Interface for collection of nation-
wide health data in Bangladesh
MIS-DGHS has established a web based data
collection system called District Health Information
System (DHIS, version 2) to collect routine health
data from the government health facilities of
Bangladesh.
The DHIS2 is a software tool for collection,
validation, analysis and presentation of aggregate
statistical data, tailored (but not limited) to integrated
health information management activities.

32. The DHIS2
It is a generic tool rather than a pre-configured
database application, with an open meta-data model
and a flexible user interface that allows the user to
design the contents of a specific information system
without the need for programming.
This database allows entry of data at the source and
creation of summary tables, charts and GIS maps
instantly for any level of hierarchy.
Therefore, this a great tool for assuming the ongoing
status of health outcome along with comparison
between geographical locations and over time.

33. The DHIS2
As part of Bangladesh’s district health information
system (HIS), which allows data to be entered at the
community level and analyzed at the central, state,
and district levels, the country adopted the web-
based platform DHIS 2 in 2009. In Bangladesh, real-
time health service use data, with particular attention
to reproductive, maternal, newborn, child, and
adolescent health (RMNCAH), are available from the
community level to the tertiary hospital level.
However, health data are being underused for health
planning purposes, because of poor data quality and
reporting

34. Why DHIS 2?
More than a decade ago, Bangladesh’s health
information system (HIS) was paper-based and built
in a disorganised manner around the unique needs
of different programmes and organisations. Health
data remained confined to programme silos with
almost no use to policy-makers and health
programme planners. At the decentralised level, the
information sent from the community clinics, Upazila
Health Complex’ and district level health facilities, to
the divisional and central levels could take up to
three months. There were heavy paperwork burdens
and the quality of the data was poor.

35. Why DHIS 2?
There was a clear need to improve governance and
decision-making through implementing an efficient
and effective routine HIS, suitable for Bangladesh’s
context.
DHIS2 was chosen because it is a free, open source
software that encourages interoperability between
programme data, making it a viable solution for the
fragmented HIS landscape in Bangladesh.

36. Current HIS scenario of Bangladesh
In just more than a decade , Bangladesh has
become the largest DHIS2 deployer in the world.
Routine health information is now available in a
timely manner, in a format accessible to all.
The comprehensive and collaborative approach to
HIS strengthening in Bangladesh has generated a
revolution in the collection and use of data.

37. Current HIS scenario of Bangladesh
The system now connects central, divisional and
district levels with sub-district health facilities and
over 13,000 community clinics.
In just four years, the reporting rate has increased
from 10 per cent at the community clinic level in
2014, to on average 98 per cent in August 2018.
Furthermore, DHIS2 has been a vehicle for data
systems improvement and other areas of health
systems strengthening overall.

38. Looking into the past: Bangladesh’s
previous health information system
In the past, Bangladesh’s HIS was a case of extreme
fragmentation. It had been built in a disorganised
manner around the unique needs of different
programmes and organisations. Health data
remained confined to programme silos, with large
amounts of overlapping data.

39. Looking into the past: Bangladesh’s
previous health information system
This lack of overview on service coverage meant the
data had almost no use to policy-makers and health
programme planners at the national level who
needed timely, complete and reliable data for
evidence-informed decision making.

40. Looking into the past: Bangladesh’s
previous health information system
Instead, policy-making was dependent on periodic
population surveys, such as the Bangladesh
Demographic and Health Survey, conducted every
three to five years.
This time-gap between the surveys limited decision-
makers capacity to make timely decisions.
Furthermore, amongst competing priorities in the
health budget, the Management Information Systems
(MIS) unit under the DGHS was not valued or given
priority.

41. Looking into the past: Bangladesh’s
previous health information system
At the decentralised level, the one-way routine HIS
also obstructed the efficient management of health
services.
Each HIS collected data from the district and Upazila
(sub-district) levels through their siloed channels,
involving different formats ranging from paper, Excel
sheets and Word documents.

42. How DHIS2 was implemented in Bangladesh
Between January 2007 and June 2008, a group of
experts under the MOHFW joined forces with the
WHO’s Health Metrics Network to assess the status
of Bangladesh’s HIS – and the context in which it
operates – against a set of international standards.
Only three of the six main components (i.e.
indicators, data sources, information products) were
assessed as being ‘adequate’ or ‘highly adequate;’
two (i.e. resources, dissemination and use) fell into
the category of ‘present, but not adequate;’ and one
component, data management, received a score of 0
– ‘not at all adequate’

43. How DHIS2 was implemented in Bangladesh
Establishing government commitment To try and
address this complex situation of extreme
fragmentation, the Bangladesh Ministry of Health in
collaboration with international development partners
launched the Health, Nutrition and Population Sector
Programme (HNPSP) in 2008.
Later, in December 2008, the Government of
Bangladesh introduced the vision of ‘Digital
Bangladesh by 2021’ – a call to action to mainstream
information technology (IT) in all areas of society to
improve transparency and promote development.
From 2009 onwards, the groundwork for digitizing
the existing HIS began, led by the MIS unit.

44. How DHIS2 was implemented in Bangladesh
A comprehensive approach was adopted to strengthen
the HIS, with four key areas:
• Systems development and implementation: Putting in
place appropriate IT software and hardware for data
collection and data management, and maintaining,
managing and further developing these systems;
• Capacity development: Building local expertise to
maintain and manage the HIS, including its technical
aspects;
• Use of information: Making information available, in
accessible formats, to all stakeholders, while instilling a
culture of evidence-based decision making, and;
• Governance: Systems and processes for managing the
country’s HIS, including coordination mechanisms,
strategic plans, and policies.

45. How DHIS2 was implemented in
Bangladesh
1. Initial phase
2. Implementation phase
3. Expansion phase: Improving data completeness
4. Capacity building phase: Focus on the ‘human
factors’ for improving information use and quality
5. Sustainability and policy phase

46. Initial phase
Key actions were:
• Building a digital infrastructure within Ministry
structures
• Carrying out a situation analysis
• Setting up a reliable online national data
warehouse
• Establishing Government commitment
• Securing necessary support for implementation

47. Implementation phase
Key actions were:
• Building a digital infrastructure within Ministry
structures
• Setting up a reliable online national data
warehouse
• Establishing ‘buy-in’ to set-up DHIS2

48. Expansion phase: Improving data completeness
Between 2009 – 2014, efforts were made to improve
systems and software, build local capacity to
maintain and use the HIS infrastructure, promote a
culture of information use at all levels of the health
system, and strengthen HIS governance.
Key actions were-
• Rolling out the initiative: Datasets from multiple
programmes migrate to DHIS2
• Improving data reporting: Training and capacity
building
• Further expansions to the community level:
Introducing individual record data

49. Capacity building phase
Focus on the ‘human factors’ for improving
information use and quality
Key actions included
• Creating ownership and increased capacity for HIS
at district and sub-district levels like HMIS
consultants & HISP
• Influencing behaviour change and motivation to use
HIS
• Making DHIS2 available for every citizen

50. Capacity building phase
• Supporting greater transparency and accountability
• Increasing access to information
• Focusing on resilience like Strengthening resilience
and emergency response capacity
• Ensuring sustainability through a coordinated,
multi-sector approach
• Engaging with patients, families and communities •
Empowering communities to have ownership and
participate in decisions and actions, and integrating
community-based systems with different levels of
the health system

51. Sustainability and policy phase
These efforts put more focus on the ‘human factors’
of sustainable implementation, aiming to change the
mind-set of health professionals to want to use
online data systems, to improve their capacity to
analyse and interpret data, and to engage with
individuals and communities to improve ownership
and accountability of the health system.

52. Sustainability and policy phase
Key actions included:
• Including DHIS2 in the health operational plan
• Sharing information and learning from experiences
nationally and internationally

54. Thank you