RATIONALISING HEALTH INFORMATION SYSTEMS TO

IMPROVE HEALTH OUTCOMES

Public Health ServicesQueensland Health

Australia1998-2000

Dr Magnolia Cardona Coordinating EpidemiologistMB.BS, MPH, Grad DAE, CHEcon

Objectives of this lecture

Provide an overview of information system types and potential uses

Increase awareness on need to balance amount of data with cost and confidentiality concerns

Present case scenarios to set up and enhance information systems

Characteristics of Good Health Surveillance Systems

Clear objectives • administration

• routine documentation

• monitoring

• research/evaluation

Simple (MDS)Standard item formatJustification and validation of items

Characteristics of Good Health Surveillance Systems (cont)

•Relevant to users•Minimum burden to providers•Amenable to modification•Provision for security/confidentiality•Associated reporting system •Feedback to collectors•Linked to action

Options

•Paper-based centralised

•Sentinel/selected surveillance

•Computerised stand alone

•Single site

•Multicentre

Options

•Computerised networked

•Encrypted data transfer

•Combination

•Paper-based notifications

•electronic entry at central location

Setting up a Health Information

System

Which option is best?

SCENARIO: Cholera epidemic in Africa

No routine surveillancePoorly kept clinical recordsUnderstaffed facilitiesUnreliable communicationsNo ongoing fundingNo computers

Cholera epidemic in Africa

Example of a paper-based system that worked in an endemic area for at least 2 years

Occupational exposure to bloodborne illnesses among health staff

Hundreds of health facilitiesInfrequent incidentsNon-compulsory recordingNo ongoing fundingConfidentiality issuesCompensation issues

Nutritional Status Monitoring in a remote indigenous community

Routine surveillance of some conditionsSomehow comprehensive clinical recordsServices staffed by communityUnreliable communicationsSome funding availableSome computers usable

•How the data will be collected•How the data will be used•Who will have access to the data•Confidentiality issues•Perceived discrimination•Financial implications

Major stakeholder’s concerns

Indigenous Community Health

Computerised systemEasy front-endComplete patient information (alias/residence)Promotes opportunistic P.H. actionCapability for health worker plans Population based reporting systemGenerates customised prevalence/incidence

Burden of depression at Medical Practitioners rooms

Non-standard recording practices ? Availability of clinical recordsBusy medical practicesVariable communication systemsLow computer coverageEthical issuesIncentives required for doctors

Doctors-based Sentinel Surveillance

•Enables documentation of non-hospital data•Burden of disease measurement•Paper-based with weekly notifications•Limited patient information & # conditions•Selected Locations (self-selected doctors)•Inability to calculate prevalence/incidence

Example of project to maximise efficiency of existing health

information systems

Real case scenario

Improve health outcomes through enhancement of

Public Health information systems

Aim

Objectives High quality /timely data Minimise duplication/cost Standard coding practices Common table structures Common operating environment Shared hardware Data Linkage

Inventory of DatabasesPurpose/Scope /ContentsSize/AccessibilityOperating system/server/interfaceData tablesRemote access/re-developmentSpecial requirementsStaff involved

Integration Protocols

Hardware /softwareData definitions {NHDD}Reference tablesData Entry & TransferSecurity /Confidentiality

Working Group Discuss IT requirements Re/development experience Security Principles Sharing of reference tables Integration protocols Recommendations

Network (WAN, LAN)

Platforms (hardware)

Database (execute instructions)

Data use (structure)

User interface

Business LevelsIntegration

Business

Interface

Data use

Database

Platforms

Network

*BSR PSR Lead *NOCs VIVAS *MODDs

How does this improve Health Outcomes?

Outbreak response/timingImmunisation ratesPrescription controlStandard Indigenous identifiersEarly cancer detection\QA

SummaryRelevance & cost-effectivenessConsultation with users and data

holdersFinancial considerationsEthical implicationsUltimate goal to improve health