Forging a (ehealth) health Information System - A Multi-Axial enterprise approach

6th HELINA Conference, Abidjan, 2009

Forging a Health Information Systems Framework:

A Multi-Axial Enterprise Approach

Dr Ime AsangansiHealth Information Systems Programme, Nigeria

& University of Oslo, [email protected]@matnat.uio.no

mailto:[email protected]

mailto:[email protected]


Presentation

• Introduce terms and concepts• Offer a practical tool• Stimulate inquiry


Questions• What is a (health information)

system/infrastructure?• What are the existing systems/components?• How do these inter-relate/integrate?• What framework could unite all these?


A system• Actors• Behaviour• Heterogeneity• Interdependency• Scaling /hierarchy• Non-predictability

6th HELINA Conference, Abidjan, 2009J. Yasha Kresh Integrative Systems View of Life: Perspectives from General Systems Thinking p8 in Complex Systems Science in Biomedicine Ed. Deisboeck TS and Kresh JY Springer NY 2006 ISBN 0-387-30241-7


Problems• Fragmentation• Issues with communication/collaboration• Silo thinking – lack of awareness of other

possibilities


Common understanding 2

06/02/12 8Lubinski


What is the need for a big picture/framework?

Results

Our Goals

Actors & actions

"Side Effects"

Actions ofothers

Their Goals


Managing Complexity

Arnie Levin, New Yorker, December 27, 1976

Michael L. Deaton – Univ of Pitt Environmental/Health Summit, 2007


Managing Complexity – “silo” thinking




Complexity – systems/framework thinking(Consequences)




So, what are the existing health information systems? - Architectures, Frameworks, Applications

What are their components?• Actors• Processes• Domains• Hierarchy


Multi-axial (modular) Framework• Should take into considerations all the

components separately – actors, processes, domains, hierarchy

• Decomposable high-level framework into lower-level matrices and practical artefacts

• Continuously developed based on action research methodology – loops of observation, reflection and use (action)

• DHIS as national system


Actors (Types)

Hierarchy

ProcessesModulesDomains

National

People - Paper-based, electonic tools Hardware & communication arch.Data elements/Indicators

Public Health/StatisticalEMRs/EHR modules

Administrative systemsSupply (drugs, etc)

management systemFinancial systems

ICT support systemSocial welfare/faith-based

systems

PlanningRequirements specification

Information cyclesM&E (input, processes, output,

outcome)Deployment

Verification/TestingOptimization

Maintenance/Support

Household

Community

Facility

LGA (district)

State


Household Community

Facility LGA State

People Family membersIndividualsTBAs

Village Health workersCHEWsTBAs

Clinicians,PharmacistAnd other workers

M&E officersDistrict workers

Public health physiciansEpid.Statistician

Tools Household forms – child health cards

Community health forms

Facility registersEMRs

LGA formsDHIS + Statistics

State summaryDHIS

Hardware Mobiles, TV,Internet

Mobiles Mobiles e.g DHIS MIDP

Computers ComputersInternet

Data elements/indicators

Person unique identifiers,Household data elements

IdentifiersHealth profileCommunity tally sheets

Health facility data set

District minimum dataset

State minimum dataset/indicator

Matrices from the Framework


Example – Actors vs. HierarchyHousehold Community Facility LGA State

People Family membersIndividualsTBAs

Village Health workersCHEWsTBAs

Clinicians,PharmacistAnd other workers

M&E officersDistrict workers

Public health physiciansEpid.Statistician

Tools Household forms – child health cards

Community health formsJavaRosa

Facility registersEMRs – OpenMRS

LGA formsDHIS + Statistics

State summaryDHIS

Hardware Mobiles, TV,Internet, Computers

Mobiles Mobiles e.g DHIS MIDP

Computers ComputersInternet

Data elements/indicators

Person unique identifiers,Household data elements

IdentifiersHealth profileCommunity tally sheets

Health facility data set

District minimum dataset

State minimum dataset/indicator


• Reusability – design with sharing in mind• Software factories – shared IT artefacts• Taxonomic – shared terms• Ontological – shared meaning


Implications – Leaning on Game theory1. Gains in time and money across projects

2. Improved collaboration and connection between people, domains, processes and hierarchies.

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Open ‘Lego Bricks’

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22

Multi-axial enterpriseFramework

Matrices65431 2

12111097 8

National HIS Architecture

1 1172

National HIS Solutions

B BAA

HIS SolutionsAAAAA A

BBBBB B

Modified from Lubinski


• Collaboration based on HMN tools viz-a-viz multi-axial enterprise framework

• Further development & testing- AR• WHO Bulletin (IJPH) paper on HMN -upcoming• MEDINFO 2010 Panel• Further work on “generativity and innovation in

the health information system framework/infrastructure”


• Merci beacoup!

Forging a (ehealth) health Information System - A Multi-Axial enterprise approach

Health & Medicine

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