Routine health information system(RHIS)/Health

LECTURE -5:Management Information System

(HMIS)
 Session objectives

At the end of the session, the students will be able to:

• Define HMIS
• Understand components of the HMIS
• Define data quality and its dimensions
• Define indicators
• HMIS is the routine collection, aggregation, analysis,
presentation and use of health related data for evidence based
decisions for health workers, managers and policy makers.
• It provides information at regular intervals, through routine
mechanisms to address health information needs.
• HMIS is an essential tool for strengthening planning

and management in the health facilities.

• It enables monitoring of service delivery in terms of

coverage, human resources, disease profiles and

health outcomes.

• Usually provides routine health institution based

information.
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It includes systems for collecting and using
• Health services data
• financial data
• Surveillance data

• Vital events data.

An effective HMIS has two main objectives:
• producing high quality routine health information
• effective use of the routine health information for decision-
making.
• The ultimate goal of the HMIS:

is to generate quality data and use that data for

management decisions to improve health service
provision.
 Purposes of HMIS

• Routine collection and aggregation of quality health

information
• Availing accurate, timely and complete data

• Providing specific information support to health

decision making process
• Strengthening the use of locally generated data for
evidence based decision making
Components of HMIS
A. Information management

• Data collection: Recording of health data using individual and

family folder, registers, tally and reporting formats.

• Data processing: is a process of cleaning and aggregation of

data.

• Data analysis and presentation: is a process of interpretation

and comparison of generated information in the form of
sentence, tables and graphs.
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Components of HMIS…
B. Using information for management purposes like:
• Problem identification: identifying problems using key
indicators
• Prioritizing problems and decision making: Problems
identified should be prioritized and decided what types of
actions need to be taken.
• monitoring: Assessing whether the desired result has been
achieved.

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• Decision-making: Decide what types of actions
need to be taken.
• Action taking: Implementing the agreed
action.
• Evaluation: Assessing the desired result has
been achieved.
• In Ethiopia, HMIS is considered as a backbone of health care

delivery.

• It has been implemented since 2008 G.C.

HMIS emphasizes on:

• improved HMIS information use

• improved data quality,

• decreased data burden

• improved ICT support.

three guiding principles of HMIS are
1. Standardization
• Common definitions of indicators
• Disease list for reporting & case definitions

• Recording & Reporting forms

• Procedure manual throughout health sector

2. Simplifying
• Reduce number of data items, limited to those required by indicators selected
and user friendly forms and procedures

3. Integrate
• Single reporting channel
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o HMIS weaknesses manifest in several ways:

• Incomplete institutionalization
• Unstandardized data collection
• Weak information use (analysis and interpretation).
• Limited resources for HMIS(computers, finance…)
 HMIS Recording and Reporting Tools

• Individual Medical Recording tools: Are tools

which are used to record the medical and clinical
information of individual clients and/or patients.
• Medical record includes documented data on
past and present illnesses and treatment written
by healthcare professionals caring for the patient.
Medical record should provide accurate
information on:
• Who the patient is and who provided health
care;
• What, when, why and how services were
provided;
• The outcome of care and treatment.
 Four major sections of medical records :

• Administrative: which includes demographic and socioeconomic data such as

the name of the patient (identification), sex, date of birth, place of birth,

patient’s permanent address, and medical record number;

• Legal data: including a signed consent for treatment by appointed doctors and

authorization for the release of information;

• Financial data: relating to the payment of fees for medical services and

hospital accommodation; and

• Clinical data: on the patient whether admitted to the hospital or treated as an

outpatient or an emergency patient.

 Purposes of individual medical record

• Communication (To communicate between attending

healthcare providers)
• Continuity of patient care (present and continuing care of
the patient.)
• Evaluation of patient care (course of the patient's illness and
treatment)
• Medico legal (as legal document)
• Statistical purpose (health statistics and research)
• Research and education
• Historical purposes
• As a reference for official reports
 Common components of each individual medical record

I. Integrated individual Folder VI. Tracer card

II. Individual Summary Sheet VII. RH/ANC card

III. Patient Card VIII. Woman’s Card

IV. Service ID Card XV. Appointment card

V. Master Patient Index X. Other cards

1.1. Routine Data collection tools
A. Individual Medical Record: are life time records which
document the course of the patient's illness and treatment;
and provide continual care and treatment for the patient.

Hospital/HC: HMIS individual Health post: Family folder

patient MR
and health cards

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Individual Medical Records

• Medical records are lifetime records.

• Kept by healthcare organizations.
• Record - property of the Facility.
• Data - property of the Client.

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 2. Register
is a form/tool that is used to record the abstract information
from each service/ department required by indicators.
• Registers are records of data that need
continuity - i.e. for conditions that need
follow-up over long periods such as ANC,
immunization, FP, TB or chronic illnesses.
 Characteristics of registers include:

• Every register has columns & rows

• Each row contains information for one patient

• The column contains information about that patient, and one piece of
information per column is available

• Contains reportable and non-reportable data elements

• Are data sources for computation of HMIS indicators

• Most registers have tally sheet, those registers which don’t have tally
sheet have a box for computation of reportable data elements.
there are 36+ registers
Eg. MCH registers (14):
o TT Register
oFamily Planning Register o Human Papilloma Virus (HPV) im-
o Long acting FP Removal munization Register
Register
o Pregnant & Lactating Women Nutri-
o ANC Register
o Delivery register tion Screening register
o PNC Register o Therapeutic Food Program (TFP)
o PMTCT Register Register
o Abortion care Register
o Neonatal and Intensive Care Unit
o Infant Immunization &
growth Monitoring (NICU) Register
o Comprehensive & Integrated Nutri-
tion Screening register
 Common Elements of All Registers

• Identification:
– Registration Number: sequential number.
– Medical Record Number (MRN): Card number
– Name: clients’ full name
– Age: age in years/ in months
– Sex: M for Male and F for Female
• Address: Region, Woreda, Kebele, Gott and House
number
• Date: All dates are written in the EC as
Date/Month/Year (DD/MM/YY)
 There are two types of registers:

• Serial (Case) Registers: Each subsequent visit is registered as a

new entry. E.g. OPD, VCT, Abortion registers...

• Longitudinal Registers: Each client is stayed in the register so

long as s/he is in the service. E.g. EPI, ANC, FP, ART, TB.

• There are about 36 Registers including logbook and 15 tally

sheets in the current Ethiopian health information system. MCH
registers (15), Disease Prevention and Control Registers (10) and
others (11).
 3. Tally Sheet
• is a piece of paper that is used to mark the number of clients
that used specific services/received a care.
• Tally sheets are an easy way of counting (tallying) data on
identical service or care.
there are 15+ tally sheets
E.g. MCH tally sheets (8):

o Family Planning Service Tally o Pregnancy testing tally

o Family Planning Methods o Abortion Tally

Dispensed Count Tally o Immunization tally

o ANC Tally o Comprehensive & Integrated

o PMTCT tally Nutrition Service (CINuS) Tally

Others tools are

• Laboratory forms
• Referral forms
• Growth cards
• Health unit report forms
• Supervisory checklists
 Information hierarchy in HMIS

• RHIS reports of health institutions pass

through an integrated and only one channel.
• Routinely collected data from service
units/departments are compiled by HIS.
 Who collects??
• Most RHIS data are generated at health facilities.

• The RHIS gathers data from all participating facilities, including MOH,
NGO, private for profit, and other governmental organizations.

• Health facilities check and review HMIS data and then forward it to their
administrative office.

• The administrative level that receives data from facilities aggregates the data
by facility type.

• The administrative office aggregates the data, and forwards the HMIS report
to the next level.
• Other data that have an influence on health care
provision may be available from other sectors, from
surveys, etc.
• While these data may be important for health sector
decision-making, they are not collected through the
HMIS and are not a part of the HMIS data flow.
 What HMIS reports??
• Facilities report on the services they provide, the
disease cases they see, and on administrative data
such as human resources etc...
• When: Facilities aggregate, review and report their
data monthly, quarterly and annually.
• Administrative levels also submit their data on a
monthly, quarterly and annual basis.
 HMIS Reporting channel and period

• Health posts will submit their report to their cluster health center, which then

compiles data from the health center and health posts to send to Woreda Health

Office.

• Woreda Health Offices compiles routine reports from the health centers and

from the WoHOs and send it to the ZHDs.

• Zonal Health Departments then send their report to the RHB and then to the

FMOH.

• For regions that have no functional WoHOs, health facilities will send their

report to ZHDs (Example: Addis Ababa city Administration).

• For regions that have no functional ZHDs, the WoHOs will send their

report to the RHB.

• Regions without ZHDs, monthly report is from the 21st of the previous
month up to the 20th of the reporting period.

• Example: For Tikimt 2009 EC monthly report, the data should be collected

from Meskerem 21 up toTikimt 20, 2009.

• The reporting channel and period of public, private health facilities and

administrative health units will follow the following schedule, as depicted

in the table.
Indicator in HMIS

• Is a variable that measures a particular aspect of a program.

• Is a variable whose value may be changed with intervention.

• Indicator is a variable that evaluates status and permits

measurement of changes over time.
• Is a measurement that measures the value of the change in
meaningful units that can be compared to past and future units.
• Clear indicators are the basis of any effective
monitoring and evaluation system.
Definition of Health Indicator:
• Is avariable that are used to measure change of health service status
over time.

• It is a measurable characteristic that describes: the health of a

population (e.g., life expectancy, mortality, disease incidence or
prevalence, or other health states) and determinants of health (e.g.,
health behaviors, health risk factors, physical environments and
socioeconomic environments).

• In Ethiopian HMIS, there are 131 indicators.

 Benefits of Health Indicators

• Indicators are powerful tools for monitoring and communicating

critical information about population health.

• Indicators are used to support planning (identify priorities,

develop and target resources, identify benchmarks) and track
progress toward broad community objectives.

• Inform policy and policy makers, and can be used to promote

accountability among governmental and non-governmental
agencies.
 When should indicators be developed?

• Indicators should be developed at the beginning

of programs.

• It can help researchers and program managers

track program progress over the life of the
program as well as measuring the results of the
program at the end.
Types of indicators

Health indicators can be classified as input, process, output,

outcome and impact indicators.

• Input indicators: used to monitor affordability and measure

availability of resources.

• It measure resources devoted to a particular program or

activity (e.g., number of hospital beds, number of case

workers, vaccination doses purchased).

• Other indicators are buildings, equipment,

supplies, and personnel.

• Input indicators can also include measures of

characteristics of a target population (e.g., number

of persons eligible for a diagnostic trial).

 Process indicators
• monitors activities that are carried out and
measures accessibility of services coverage
and quality.
• It looks at the ways in which goods and
services are provided.
• In the context of health care, they often measure the
consistency or timeliness of activities carried out in assessing
and treating service recipients (e.g., diagnosis error rates,
order fill rates, stock wastage due to expiration or damage)
and in some cases, compliance with recommended practice
(e.g., percentage of children 0-24 months immunized,
percentage of pregnant women tested for HIV).
Output indicators: monitors results of activities and measures acceptability.

• It measures the quantity of goods and services produced, the results of

process activities, or the efficiency of those activities.

e.g., live births per caesarean deliveries performed, post-surgical infection rate).

• Outcome indicators: measures/monitors change in health seeking behavior

and attitude of populations.

• Impact indicators: monitors changes in health status of populations.

• It also measures appropriateness, effectiveness, equity and sustainability.

 Key Performance Indicators (KPIs)

• KPIs are measures that organization uses to define success

and track progress in meeting its strategic goals.

• This focus on strategic or long-term goals is what

distinguishes KPIs from “performance indicators” (PIs) that

do not necessarily rise to the attention of policymakers or the

public, but may be important for public sector managers.

• Within any health system, there can be many indicators of performance,

from the facility level (hospitals, clinics, pharmacies), to the district level,

all the way up to the national level.

• Yet, only a selected group of these indicators are systematically measured,

aggregated, and tracked at higher levels.

• These KPIs are used because they highlight those aspects of performance

that are integral above all others in providing insights on attaining the

health sector’s strategic goals.

Well-designed KPIs should help health sector decision makers to do a number

of things, including:

• Establish baseline information (i.e., the current state of performance)

• Set performance standards and targets to motivate continuous improvement

• Measure and report improvements over time

• Compare performance across geographic locations

• Benchmark performance against regional and international peers or norms

• Allow stakeholders to independently judge health sector performance.

Four thematic areas of indicators
• Family health
• Disease prevention and control
• Resource indicator
• Health system indicators
Family health indicators
• Reproductive health
• Child health
• EPI (Immunization and growth monitoring)
Disease prevention and control indicators
• All diseases
• Communicable diseases (major, other)
• None communicable disease
• Environmental and personal hygiene
Resources indicators
• Assets
• Human
• Logistics
• Finances
• Laboratory
Health system indicators
• Health service coverage and utilization
• Management
• HMIS and M & E
Key Performance Indicators In Ethiopian HMIS

• There are 21 HMIS indicators that FMOH selected

for routine monitoring of key aspects of the health
system performance.

• Every Administrative/health facility unit displays

these indicators as relevant, and routinely reviews
during performance review meetings.
 Factors affecting successful implementation of HIS in the Ethiopia

• A Complexity of medical data and information

• Clinical information ages rapidly.

• Maintaining the database is difficult

• Proportion of budget spending on ICT is low

• Education and Training of system users ( cost of capacity building) is high

• Poor linkage between information sources and limited Information use for decision making

• Standards in clinical terminology and concerns on data privacy and security

• Challenges of data entry and difficulty in interpreting record with other
information sources and systems
• Shortage of ICTs and in adequate skilled human power (HIT) for all facilities
• system failure and high maintenance costs
• In adequate horizontal and vertical communications and power
infrastructures
• In adequate institutional arrangements
• Limited data management capacity and in adequate band width nationally
and on the gateway
Thank you
 QUIZE(5%)
1 what is the ultimate goal of HMIS
2 list factors affecting sucssusfull implementation of
HIS in Ethiopia
3 list thematic area of Ethiopian national indicator
4 how many updated health indicators are available
in Ethiopia
5 describe the guiding principle of HMIS